tme: 



HYDRIATIC TREATMENT 



OF 



TYPHOID FEYER 



ACCORDING TO 



Brand, Tripier and Bouveretj and Yojl. 



BY 



CHR. SIHLER, M. D., Ph. D. 

Professor of Histology in the Medical Department of the Western Reserve 
University, lormeiiy Fellow of the Johns Hopkins University 
and Assistant in the Biological Laboratory. 




Entered, according to Act of Congress, in the year 1891 br 
CHR. SIHLER, M. D., Ph. D. 



Press of 

Publishing House of the Reformed Church, 
1134—1138 Pearl St. Cleveland, 0. 



"3raub as well as suffering l|nmanitY ts unber 
obligations to you for unbertaftng tbe introbuction of 
tt]is erccUent metl^ob in your country." 

From a letter of Dr. vogl to the author, 
oooooooo 



"3 ^^^^ ^^c> boubt, tt|at Dery many persons l^ar>e 
bieb in tt^e Unitcb States of typt^oib fet)er ml^ose Iipes 
moulb \}avz been saveb (by ^ranb's mett^ob) if tl]e 
Zlmerican niebical profession l)ab risen aboc»e tt^e op= 
position of tl?e laity anb abooe its oipn prejubices." 

From H. C. "Wood's Therapeiitic, 



<]xp> 

(1) Id the first place I wish to thank Dr. 
Brand, Drs. Tripier and Bouveret and Dr. Vogl 
for allowing me to make translations from their 
writings. The physicians, who will follow the 
advice these men give, will, I ventnre to say, 
thank them twofold, and the patients and their 
friends benefited by their writings threefold. 
By these words I do not wish to imply that 

I subscribe to every single utterance in this 
book. 

To Dr. John H. Loivman also, my colleague 
and friend, T am under obligations for aid and 
advice in the preparation of the manuscript. 

(2) Any remarks of my own while trans- 
lating the writings of my authorities are in- 
cluded in brackets, often with an B. 

(8) The centigrade scale is used in tliis 
volume for thermometric measurements. In a 
great many instances the corresponding figure in 
the F. scale is added. For the instances where 



this is not done I add further the foUowing table 
giving tlie centigrade scale from 42 to 14° in the 
F. scale. 



Celsius. 


r ciiirf Illicit. 

i 


Celsius. 


Fahrenheit. 


AO f\ 

4:1 .0 


1 7 <-I 

1 7 


30 


86.0 


i 29 


84.2 


41.0 

40.5 




i 28 


82.4 


' 27 


80.6 


40.0 


104.0 


26 


78.8 


39.5 


103.1 i 


25 


77.0 ... 




39.0 

38.5 

38.0 


102.2 , i 


; 24 




101.3 


23 


73.4 


100.4.. . 


22 


71.6 




99.5 


: 21 


69.8 


37.0 


98.6 


i '>0 


68.0 








36 


96.8 , 


1 19 


66.2 


i 


; 18 


64.4 


34 


93.2 


: 1^ 

16 


62.6 

60.8 


33 

32 


91.4 

89.6 ! 


In 


nC) 0 




31 


87.8 ; 


14 


57.2 



(3) It may be of interest to note down here 
that the surface of the human body measures 
about 15 square feet. 

(4) It will be noticed that in the introduc- 
tion I say that the treatment of the comj^licated 
and neglected cases will be but lightly touched 
upon. After correspondence with Dr. Brand I 
concluded to treat this matter quite fully devot- 
ing 63 pages to this topic. 



(5) I hope that the members of the profes- 
sion of the English tongue will not be slow in 
following the example of their French confreres. 
The volume speaks about the introduction of 
the method in Lyon and how it steadily gained 
friends, it relates however also that at the time 
when the bulk of the profession in Lyons were 
already adherents to the method, in the academy 
of medicine in Paris Dujardin — Beaumetz an- 
nounced that the method of Brand had been 
abandoned as useless, so that Glenard was 
obliged to protest against this statement adduc- 
ing as testimony contradicting this announce- 
ment the declaration of 24 phycisians of Lyons, 
see pg. 38. Now, however, a change must 
have overtaken the Academy, a change of opin- 
ion which has always followed the unprejudiced 
observation of the workings of the method. At 
least — so I am informed by Dr. Brand — the 
Academy of Medicine of Paris has announced a 
prize of 5000 Frnks., for the best ivorh on the hy- 
driatic treatment of typhoid fever . 

May this little book be of some aid in bring- 
ing about a change of opinion on the value of 
the Brand method in the United States (and 

vii. 



perhap? elsewhere) so that we, though slow in 
giving the method a trial, may not be the last 
ones whose patients derive the benefits of the hy- 
driatic treatment. 

Chr. Sihler. 

December 10th, 1891. 
832 Scranton Ave., Cleveland, O. 



Tiii. 



conte::nts. 

<xx> 

Page. 



Introduction 1 

Chapter I. Why are we justified in employ- 
ing the cool baths in the treatment of 

Tjhoid Fever 12 

Results obtained : Muenich 15 

Stettin 25 

German Army 31 

France (Lyons) 34 

Practice amongst children 48 

Gross results 49 

Perfect execution of the method 54 

Is the method dangerous ? , 59 

The pleasant and unpleasant features of 

the method, 61 

Resume of Chapter I. 03 

Chapter II. The influence on the difierent 

organs, functions and symptoms 65 

Influence on temperature 66 

Circulatory organs 82 

Aespiratory organs 92 

Digestive organs 93 

Urinary secretion 104 

Skin 112 

Nervous system 113 

General course of the disease 120 

Resume of Chapter II 124 

ix 



Chapter III. Indications and method 127 

Tlie til lee indications 128 

Execution of metho'l in uurnial cases ]40 

The cold full bath 143 

Cold compresses 147 

Temperature of bath 148 

Frequency' of baths 150 

Duration of bath 154 

Number of baths , 156 

Thermometrical measurements 158 

The luke-warm bath with cold affusions.. 101 

Ziemssen's method 163 

Execution of the method in special types 

and conditions 164 

Grave cases and cases of medium gravity 164 

Mild forma 168 

Afebrile forms 168 

Children 169 

Old people, 170 

Pregnancy and m. nstruation, obesity, 

')rganic heart-disease sweating... 171 
The treatment of complications and of 

cases that come under treatment 

late, after T. <S: B 172 

The treatment of the "degenerated'\cases 

after Brand. 195 

Diet, Hygiene and Medication 235 

Resume of Chapter III 238 

Chapter lY. Illustrative Cases 242 

5 cases after T. & B 242 

10 cases after Brand 265 

Appendix A. Personal experience in tlie exe- 
cution of the method 299 



Introcliictioi\. 

i3i i^D <in (3i 

w w tt* vi7 

The purpose of this little volume is to in- 
duce and enable the medical profession of the 
United States to use the hydriatic method in the 
treatment of typhoid fever. I think that any 
one who should feel inclined to try the method, 
would feel the want of a book, which might en- 
abhi him to become thoroughly familiar with the 
details of the method, to enter fully into the 
views of the masters of the art, to give him a 
rationale or at least a theory for its mode of ac- 
tion, to inform him about modifications necessary 
in special cases, to detail to him a number of 
typical, illustrative and unusual cases, and to 
state the results obtained by others. There are 
now in existence excellent books in other lan- 
guages meeting such demands, the latest one by 
the French professors and physicians Tripier and 
Bouveret. Being convinced of the great value 
of the hydriatic method, and wishing the same 
to be employed amongst my countrymen, I in- 
quired of six prominent medical publishers, 
whether they would be interested in the publica- 
tion of the translation of a standard Avork on 



this subject. All six declined, stating that such 
a book would not find a market, one of the 
answers being the following : ''Dear Sir. — Re- 
plying to yours of the 12th inst., oJffering a 
translation of a work on the hydropathic treat- 
ment of typhoid fever, we have to say, that it 
does not seem to us that such a work would find 
a very receptive market. That form of treat- 
ment has been talked of and written on by many 
of our medical men ; but so far as we know it 
has not as yet been received with the enthusiasm 
which is necessary to warrant the publication of 
a work on the subject. Later on, perhaps, there 
may be a market for such a book." 

While the answers from the publishers were 
discouraging, shovring the lack of interest in this 
question amongst the profession of the United 
States, they on the other hand were a source of 
stimulation, to fresh activity, inasmuch as they 
revealed the fact, that there was here a chance 
for missionary work in a field which promised 
many good results. I therefore concluded to 
publish at my own expense a little volume pre- 
senting such points, as I myself, when unter- 
taking the use of the method, was desirous of 
having access to, and which would enable any 
one to undertake and begin using the method. 
Tripier and Bouveret have kindly allowed me to 
inake translations from their book and Dr. Brand 



— 3 — 



has sent me from his library books otherwise dif- 
ficult to obtain. 

The volume then is essentially a compilation 
(1) from the work of Tripier and Bouveret, La 
fievre typho'ide traitee par les bains fr olds. Paris, 
Baillere et fils, 1886, the German translation 
of which by Dr. A. PoUak, {Tripier and Bouveret, 
Die Kaltwasserhehandlung des Typhus, Arnoldi- 
sche Buchhandlung, Leipzig, 1889.) w^as used 
in the preparation of this work; (2) from Brand, 
Die Wasserbehandhmg der typhdsen Fieber, 2, 
Auflage, Tuebingen 1877, Lauppsche Buchhand- 
lung, (3) from the writings of Vogl the most im- 
portant of which have been published in the 
Deutsche Archiv fiir klin. Medicin, Bd. 36, 37, 
43, 44 and in other journals. It would of course 
have been just as easy a task, if not easier, to use 
my own words in reporting the work of others, 
but those, who should feel inclined to use the 
book as a guide, will undoubtedly do it with 
more confidence, if they can read the ipsissima 
verba of masters in the art, and I hope this fact 
will not detract from the value and usefulness of 
the book. Undoubtedly there are other men 
more competent for this task. But w^hen the 
Priest and the Levite pass by, without noticing a 
good thing along the roadside, the Samaritan may 
be excused for taking hold of the case. In ray 
opinion a book of the kind I present here, should 



— 4 — 



have been made accessible to the medical profes- 
sion of this country ten years ago, because 
Brand's second edition was published in 1877, 
and this book gave the results of over 8000 
cases, the observations having been carried on 
over a number of years and by numerous compe- 
tent observers, clinicians and private practition- 
ers, civil and military physicians, the reports 
of all these observers speaking in favor of the 
method. 

I myself had expected that such an author- 
ity, as the American System would at least have 
given an account of the method of Brand. It 
is true the article on enteric fever speaks of cold 
water in discussing the treatment. It is spoken 
of however as a remedy ajDplicable when typhoid 
fever assumes a severe form as a kind of dernier 
resort, while Brand says that it is used and must be 
used &e/o7'e the disease has assumed a severe type, 
and that Avhen it has reached that stage, the best 
chance for cold water to do good and produce its 
legitimate effects has passed by. ' 'One of the first 
symptoms to demand attention," the article con- 
tinues, ''is the high temperature." But Brand ad- 
vises the use of water just as well in the hypothermic 
forms, and where the tem2^eratures are not exces- 
sive, and in his first edition on the hydriatic treat- 
ment of typhoid fever, lie mentions inthe /fr,"?^ 
})lace those "stimiihiting' ' qualities of the cool 



— 5 — 



bath, by virtue of which all the favorable changes 
in the digestive, circulatory, nervous, etc. organs 
are brought about. Further, the article says 
that the hydriatic method depends for its efficacy 
upon its power of abstracting heat from the body 
and is useful just in proportion as it does this 
and that, and there is no reason for believing that 
it has the power to modify the conditions, upon 
which the production of heat depends, while 
Vogi and others have shown that even before the 
maximum temperatures show a decided decrease, 
there is a permanent amelioration of many or 
most of the symptoms, and that a steady and sure 
redujction of the maximum temperature from day 
to day can be brought about, this fact showing 
that the treatment has indeed a power to modify 
the disturbed heat-regulating organs and not 
merely to relieve the organism for a short time 
of the high temperature. Finally Liebermeister 
is mentioned as the guide and authority for the 
application of the method, but Brand says: '^I 
am sorry to say, that I have to part company 
with Liebermeister, Hagenbach, Ziemssen and 
others, men towards whom I entertain the deepest 
feeling of gratitude and the highest respect. All 
of these men do not carry out the water-treat- 
ment systematically, as is generally taken for 
granted ; they use a treatment into which both 
the antipyretics and water enter and they have 



- 6 — 



for their way of treatment different indications 
from those of the systematic water-treatment." 

I must jDrotest then against the notion, that 
in the American system the hydriatic treatment 
of enteric feyer is jDresented and explained in an 
adequate way ; its commendation is so half- 
hearted, that I think I remain within the province 
of truth when I say, that on the strength of the 
treatment it has receiyed there, next to nobody 
will haye made use of it. And then if one reads 
the objections mentioned on page 328, one cer- 
tainly feels as though the method was mentioned 
with the purpose of adyising others to let it 
alone rather than to employ it ! 

I cannot refrain from quoting a few lines 
more, to show how little the writer of the article 
has entered into the spirit of the method. ''I am 
indisposed," he says, to haye recourse to it (the 
cold bath) except in cases of hyperpyrexia of such 
intensity, that death seems imminent and only to 
be averted by energetic treatment, or in cases in 
which other antipyretic remedies have failed to 
reduce the temperature, and for the following 
reasons: 1. In the first place it is generally pos- 
sible to produce a decided effect by the other 
methods of aj^plying the cold water treatment 
with much less discomfort to the patient. 2. In a 
private house it is not always practicable to liave 
a l^ath brouglit to the bedside of the patient, and 



in a general hospital to do so would occasion a 
good deal of annoyance to the other patients in 
the same ward, and I have seen ill results from 
carrying him some distance to the bath room. 
But even where the bath is brought directly to 
the bedside, it involves so much movement and 
is sometimes the cause of so much excitement, 
that its good effects are more than neutralized by 
its bad." 

I think he, who will study the writings of 
men who have had much experience in the use of 
the cool baths, or he, who will try the method 
himself faithfully, will support me in my state- 
ment. If one should in describing the antiseptic 
method of treating wounds, fail to speak about 
cleaning the field of the operation, say nothing 
about clean sponges and instruments, if he should 
allow the wound to be plastered up as in old times, 
and only then, if the wound were surrounded by 
phlegmonous inflammation and the patient suf- 
fered from high fever, advise the opening of the 
wound and washing the same with antiseptics, — 
he would do as much justice to Lister as the 
American System has done to Brand. To my 
mind it is certain that such a presentation of this 
important method has done very little or nothing 
to propagate the use of the cold bath treatment 
in the United States. 

The profession then lacking a convenient 



book illustrating the method, I have not con- 
sidered it out of place to issue this little volume, 
especially if it is true what H. C. Wood says: 
have no doubt that very many persons have 
died in the United States of typhoid fever whose 
lives would have been saved (by Brand's method),, 
if the American medical profession had risen 
above the opposition of the laity and above its 
own prejudices." 

How many then do die? In the census of 
1880 Dr. Billings gives the number of deaths 
from enteric fever as over 22,000. Xow it has 
been found, that where the method has been, 
carried out Avithout any claims to great accuracy 
the mortality has been reduced 33 per cent, and 
where it has been carried out systematically the 
rate has been reduced 66 per cent, and where 
the j^hysicians had the aid of the public (by their 
reporting early and following the directions 
closely) the rate has been reduced 90 per cent 
and more. Using the lowest figures it may be- 
said that 7000 lives might be saved (not to speak 
about the comfort to many more thousands) in 
the United States per year. Here in Cleveland 
we lost from typhoid fever 180 persons in each 
of the last two years, and in the fcAv years that 
I have been connected with a medical school 
here, four students and one recent graduate have 
died from tlie disease. A further incitement to 



— 9 — 



use all means at our command is the fact that 
persons in the best years of life are the victims 
and that the treatment will restore the patients 
to full health and vigor. 

It is my hope then, that a good many lives 
will be saved if this litUe book will be read and 
the advice it gives, followed. May it be the 
fore-runner of a larger and more comprehensive 
publication ''later on," e. g. a translation of the 
work of Tripier and Bouveret to which I would 
refer 'the reader, who wishes more thorough in^ 
formation. Brand's work mentioned is out of 
print. It is to be regretted, for it would be read 
with pleasure on account of its freshness. Vogl's 
writings let us hope will be published sometime^ 
if for no other reason than to show how all ob-^ 
servers who employ the method, reach the same 
results. 

Dr. Brand the author of the method is in 
private practice in Stettin, and his example ought 
to be sufficient to show that the methocl can be 
carried out in private practice, and that here m 
the very best field for its operation. Tripier and 
Bouveret are professors in the medical school of 
Lyons, France, and their book is based upon the 
study of 233 cases. Vogl is Oberstabsarzt in 
Munich and has been using the method for over 
15 years in a most thorough manner ])articularly 
amongst soldiers. 



— 10 — 



The book consists of 4 chapters, and appen- 
dix A. In the I. chapter the results that 
have been obtained so far with the hydriatic 
method are presented. In the II. chapter the 
effects of the treatment on the various functions, 
organs and symptons, as the temperature, ner- 
vous, circulatory system are given, thus furnish- 
ing a rationale for the statistics. In this chapter 
Vogl as well as Tripier and Bouveret are allowed 
to speak on the same subject and their uniform 
experience will, I hope, not fail to make an im- 
pression on the reader. In the III. chapter the 
indications are given and the method is de- 
scribed; here Brand and T. and B. have been 
followed verbatim for the most part. Lack of 
space did not allow me to follow this method, 
when treating of the special conditions. Chap- 
terlV. contains the histories of a number of cases, 
£ve after T. and B. and the rest after Brand. 
T. and B. have in their work described the 
treatment from beginning to end in a supposed 
ease, to illustrate the execution of the same. I 
think a careful study of these actual cases, where 
every measurement and every bath is reported, 
will answer the same purpose and will give a 
very accurate idea of the execution of the 
method. These cases have been selected to show 
a variety of forms, complications and difficulties 
and I hope this selection of cases may be useful 



— 11 — 



in practice. lu appendix A I have allowed my- 
self to add a few words on my own observations 
and to present a few reflections derived there- 
from . 



CHAPTER I. 



Why are we justified in employing the Brand method or cool 
baths in the treatment of typhoid fever ? 

If we stop to ask ourselves why we employ 
certain remedies or follow certain lines of treat- 
ment, Ave have I think on the Avhole two answers 
to give: and these may be best given by using 
illustrations. Thus if I were asked why I use 
quinine in malarial attacks I should say, not be- 
cause I have any theory as to how quinine acts, 
or any very definite knowledge of the cause of 
the malarial attacks, but because the giving of 
quinine has in so many cases been followed by 
amelioration of the disease, that I cannot any 
more believe that we have hei^ a simple pod hoc; 
it would be too improbable. If I were however 
asked why I give milk and alkalies in ulcer of the 
stomach, nutritive enemeta, prohibit the use of 
food, and prescribe opium, Ishould say that from 
their physiological action on the several condi- 
tions prevalent, I would expect ^ome good (more 
or less) certainly to accrue to my patient from the 
remedial agents, and in many cases a healing of 
the ulcer. As a matter of fact and not much to 
the credit of rational medicine, just for those 



— 13 — 



very remedies and lines of treatment which are 
the most certain, useful and reliable we have 
either none or very insufficient reasons and in 
fact nothing but the post hoc, but a post of such 
a formidable nature that it equals a propter. Now 
in my opinion we can give for the employment 
of the cold water treatment both kinds of an- 
swers, we can say that under its use the mortality 
has been decreased so often and with such regu- 
larity, that we cannot any longer close our eyes 
and ears to this recurring coincidence, and in 
the second place the employment of the cool 
bath has such a favorable influence on the special 
symptons and the functions of the different or- 
gans, that it cannot be otherwise than that the 
final result must be influenced for good by its 
employment. 

While the second chapter of the book treating 
of the influence of water on the special symptons 
and on the course of the disease will thus also be 
answer to the above question heading this chap- 
ter, — this I. chapter will be devoted principally to 
statistics showing what results have been obtained 
under the Brand treatment. 

The American, or in fact any other physician, 
has in my opinion no difficult task to make up 
his mind as to the value of this method, in as 
much as it has been on trial now for thirty 
years. In 1861 Brand, who has put the method 



— 14 — 



on an accurate or scientific basis, giving method 
and indications and very good provisional theo- 
ries for its use, published his first work on this 
subject. At that time one certainly might have 
hesitated, as long as there was merely the testi- 
mony of the author of the method, upon which 
to base ones judgment, — because originators of 
new lines of treatment are apt to be so enthusias- 
tic over their intellectual child, that they cannot 
see its faults and weaknesses, but at present the 
number of those having given the method an im- 
partial trial has been so large, the time, 30 years, 
during which the method has been exposed to 
criticism and trial so long, that we should have 
no difiiculty in coming to some conclusion as to 
its value. In this first chapter then I shall give 
the statistics of typhoid fever as influenced by 
the water-treatment : 

(1) of the military hospital of Munich. 

(2) of the military hospital of Stettin and 
the II. German army corjDS, Stettin being the 
headquarters of the same. 

(3) the results observed in the German army, 
comparing its mortality with other armies. 

(4) the experience of French observers. 

(5) the experience which the hydriatic 
method had amongst children. 



— 15 — 



(6) the gross available results of the method, 
comparing it with gross results of treatment in 
different hospitals and countries, other than hy- 
driatic. 

(7) the experience of those men, who have 
carried out the method in the most thorough and 
systematic manner and who were so situated and 
inclined to treat their cases from the very be- 
ginning of the sickness, thus showing what the 
method can do under the most favorable circum- 
stances. 

In 1885 Vogl published in the Deutsche 
Archiv fuer klinische Medicin, Vol. 36 an arti- 
cle entitled: Typhus TJierapie im Muenchener 
Garnisonlazareth containing the statistics from 
1841 to 1882 ; it contains the number of cases 
treated, the morbidity per thousand, the mor- 
tality per thousand as well as the percentage of 
deaths. I give this as table ^o. 1 in a condensed 
form. 

Table I. 

Showing Xo. of eases of typhoid fever in mil- 
itary hospital of Munich from 1841 to 1882 with 
No. of deaths, percentage of deaths rate of mor- 
bidity and mortality per 1000. 



— 16 — 





































































'3 






















0 




0 




















1841—43 
1844—47 
1848—51 
1852—55 
1856—59 
1860—63 
1864—67 
1868—72 
1873—76 
1876—80 
1880—83 







35.8 


45.1 


16.0 






. 18.4 


,28.3 


5.2 








38.9 


8.6 


9 I I 


997 


23.2 


44.6 


,, ,. 10.4 




240 


16.6 

20.5 


71.0 

27.9 


11.6 

5 6 


621 


127 


(6/ 


139 


18.1 


32.0 


5.0 


900 


124 


13.8 

16.6 


37.1 

39.1 


5.0 

6.3 


953 


159 


,,783 




6.4 

6.8 


29.3 

6.8 


18 


105 




0.5 







Yogi divided it into two periods. 

A. the time before the cold water treatment 
1841—1868. 5484cases— 1138 deaths.— 20. 7 per 
cent mortality. 

B. the time after the introduction of the 
cold water treatment 1868 — 1882. 2841 cases, 
348 deaths. — 12.2 per cent mortality. Difference 
-8.5 per cent mortality. 

The treatment during the first period (A) 
w^as exclusively by medicine (cathartics, emetics) 
-and bloodletting in the first years, Avhile in the 
last years from the beginning of the fifties it was 
antipyretic and stimulating: (juinine, wine, 
baths. 

Tlie treatment during the period resembled 
in its beginning for the most part that of the, 



— 17 - 



latter part of A, the baths being exhibited rather 
sparsely. Only since the middle part of the 
seventies cold water was used more extensively, 
partly combined with quinine, salicylate of soda, 
partly however the Brand method was carried 
out systematically. 132 lives were saved." 

Inasmuch as there may be prevalent in the 
minds of many the notion that if there are a 
great number of cases of a disease, there will be 
also a high percentage of deaths, it will be worth 
while to call attention to the figures in this table 
which show that in 1856 — 59 when an epidemic 
was prevailing and the morbidity was a very 
high one, the percentage of deaths to the num- 
ber of cases was very low. Objections have 
been made to assigning the very low mortality 
prevailing under hydriatic treatment to this 
method by calling attention to the fact, that 
the disease has become rarer and consequently 
milder, but this table shows that such an argument 
is not sound; there is no correspondence between 
morbidity and the benign character of the disease . 

Here I should like to say a few words on 
the great scientific value of statistics obtained in 
military hospitals. In the first place the mor- 
tality from tyyhoid fever amongst soldiers is 
naturally a high one (Brand) being as high as we 
find it in persons of more advanced years of life. 

A low percentage of deaths to the number 
2 



— 18 — 



of cases treated ^vill thus he of a good deal of 
significance. Further we all know that one of 
the many difficulties in forming an opinion of 
the value of any therapeutic measure is that the 
material which is subjected to the same treat- 
ment by different observers and in different 
periods of time — is not of the same character^ 
thus always opening the door to the legitimate 
doubt whether any given result depends more on 
the character of the material (the patients) than 
on the nature of the remedy. Xow in the case 
of soldiers we have persons of the same age. all 
of good constitution, of the same occupation, the 
same mode of living, diet, the source of infec-^ 
tion (in any single period) being also the same. 
We can therefore in this case with more accurac}^ 
compare different years, and on the other hand 
any method has a better chance to be carried out 
systematically because the soldiers being under 
medical supervision come under treatment early 
and on account of the spirit of discipline pre- 
vailing amongst them such a method especially 
as the hydriatic will be more apt to be carried 
out thoroughly. Hence the great value of sta^ 
tistics amongst soldiers. 

But the value of the hydriatic treatment be- 
comes more apparent by a further analysis of the 
facts. I shall quote Vogl himself ; he says: '"In 
the military hospitals at Munich the rate of mor- 



— 19 — 



tality in the period B, after introduction of the 
cold water treatment was, (as remarked above) 
12.6 per cent, 8.5 per cent less than in period 
A. This proportion cannot be satisfactory to 
any one, who knows by experience the effi- 
ciency and power for good of the water treat- 
ment. The figures here do not represent the 
rate of mortality under a systematic application 
of the hydriatic method: an average rate of 12.6 
per cent must be brought about by high figures 
obtained under some other method; this is indeed 
the case, inasmuch as during the earlier period 
a case now and then only was subjected to 
Brand's treatment. It will therefore be of im- 
portance to isolate a series of cases which have 
been treated strictly and methodically, and to 
place them opposite, and compare them with a 
number of cases treated differently. The ar- 
rangement in the military hospital in which the 
medical cases are treated in two stations makes 
such a comparison possible. In these two sta- 
tions the house physicians are replaced by new 
ones on October 15th of each year, and the pa- 
tients are distributed in such a way that one is 
taken to Station I. and the other to Station II.; 
in both stations they have the same wards, frame 
pavillions and nursing, so that we have here ma- 
terial for comparison so much alike in regard to 
time, locality and individuals — as perfect as one 



— 20 — 



could possibly desire. Different results in the 
number and completeness of recovery can there- 
fore be reduced by different forms of treatment 
only. Although the (hydriatic) method of treat- 
ment had been in vogue here since 1869 it was 
more of an experiment, of the results of which 
no reports exist which can be utilized for our 
purpose. It is only since 1876 — 77 that accurate 
histories of cases are in existence describing the 
treatment in the different stations and the differ- 
ent years. Since then tyj^hoid fever cases were 
treated with cold water in both stations, with a 
difference in the energy and thoroughness of the 
execution of the method. Hence it seems 
in place to divide the whole material into two 
great groups, accordingly as the treatment was 
(A) a strictly methodical one, according to 
Brand: a bath of 12°— 14° R., of 15 minutes 
duration, when the body temperature reached 
39° C. measured in the rectum; without any 
medication — place of treatment, hospital pavil- 
ions only, or (B) one deviating more or less from 
the formula of Brand, both in respect to intensity 
and duration of the abstraction of heat , combined 
with the exhibition of antipyretic remedies, place 
of treatment in pavilions during the sum- 
mer only . ' ' 

''In making such a division we cannot make 
comparisons between the cold water treatment on 



— 21 — 



the one hand and expectative or medicinal treat- 
ment on the other hand 5 but only between a perfect 
and an imperfect method of abstraction of heat, 
a circumstance which increases the precision 
(Schaerfe) of the comparison. 

"The relation between therapeutics and 
mortality can be laid down in a few theses: 

1. Almost in every year the therapeutic re- 
sults in the two stations differ; being two, three 
and four times better in one than in the other. 

2. In spite of the greatly lessened mortality 
in toto in comparison with the former years, we 
find here the rate of mortality as high as 10.8 — 
18.8, as high as in more than half of the years 
of the period of 1841—1868. 

3. This equality with the results of former 
years we find on the side of the combined method 
of treatment only. 

4. The strict and systematic hydriatic method 
with an average of 2.7 per cent never exceeds 
(even in years with many cases of typhoid fever) 
the rate of mortality of 4.7 per cent, a figure to 
which the rate never sank in the years from 1841 
to 1868. 

5 . The combined hydriatic method occupies a 
place between the results of a former method of 
treatment and the strict method of late years, 
never reaching the highest figures of the former, 
30 per cent, and never sinking to the lowest 



— 22 — 



figures of the latter, 0. per cent. This method 
approaches in its results more the older than the 
method of to-day. 

6. The total decrease of the mortality rate 
in the military hospital in 1876 — 1882 compared 
with the period from 1841 to 1875 is brought 
about principally by the reduced rate of the strictly 
systematic cold water treatment. 

A further explanation of these figures, the 
language of which one cannot designate as ^'en- 
thusiasm" I consider unnecessary. 



Table II. 

Showing No. of cases and rate of mortality in the 
military hospital of Munich from 1875 to 1882. 



1875—76 



1876— 77 

1877— 78 



1878 -79 
1879—80 



1880— 81 

1881— 82 



o 



...76 
,..66 
.194 
.141 



...56 
.115 
...92 
.110 
...98 
...16 
...25 
...22 
...42 



...0 
...7 
.14 
.12 
...3 



...3 
...1 
...2 



3.5 

3.8 

0 

6.1 

15.2 

10.8 

3.9 

18.8 

4.0 

9.1 

4.7 



15.8 Combined . 

. 4. 5 1 Pure 

. 6.7:Combined. 
Combined . 
Combined . 

Pnre 

Combined . 
Combined . 
Combined . 

Pure 

Combined . 

Pure 

Combined . 
Pure 



— 23 — 



The combined method has 767 cases, 59 
deaths, 7.6 per cent mortality. 

The pure method has 221 cases, 6 deaths. 
2.7 per cent mortality." 

In 1889 Vogl published another essay on 
the same topic; here we read: ^^I am able to add 
to these favorable results those of the years fol- 
lowing. AVe have not exceeded (with the ex- 
ception of a few tenths in 1885 — 1886 ) 

the rate of 4.7. 

We had in — 

1882 — 83 a mortality rate of 2.9 per cent. 

1883— 84 " 0.0 

1884— 85 4.1 



The number of cases treated was 141, the 
average mortality rate 3.5. Of no little im- 
portance is the increase of the strictness of the 
hydriatic method in Station I. together with the 
abstention from internal medication. 

In Station I. we had in — 

1882 — 83 a mortality rate of 5.0 per cent. 

1883— 84 ^ 4.5 
18848—5 2.8 

1885— 86 " 4.7 

1886— 87 4.0 



1885— 86 

1886— 87 



5.1 
4.0 



— 24 — 



The number of cases treated was 144, the 
average mortality rate 4.1 per cent. 

Adding the cases of both Stations we find 
cases 1273, deaths 76, giving a mortality rate of 
6 per cent." 

This rate of 6 per cent however does not do 
full justice to the water treatment, inasmuch as 
it contains cases not treated strictly. Comparing 
it with the old rate of 20.7 we can see its value. 
Let us also remember that these low figures have 
not been a lucky accident occuring in one or two 
years, but that the observations have been car- 
ried on for 12 years and more. Let us further 
take notice of this fact, which stands out where- 
ever the method has been used, that when the 
method was carried out partially the good re- 
sults were only jDartial, and that strictly with 
the more perfect carrying out of the same there 
went hand in hand the decrease of the rate of 
deaths; we cannot therefore appeal to chance in 
explaining the coincidence of the use of Brand's 
method and the decrease in the deaths from ty- 
phoid fever. 

A further evidence in the same direction 
Table No. III. showing the Xo. of complications 
under the strict treatment and the combined 
treatment. 



— 25 — 



Table III. 
Showing the per cent of complications. 



Complications. 



Combined method, 



Xo. 



Per cent. 



Pure method. 



No. 



Per cent. 



Bronchial affections.. 
Croupous pneumonia 
Laryngeal affections. 

Pleurisy 

Erysipelas..... 

Epistaxis 

Affect, of ear 

Cerebral affections... 

Profuse sweating 

Venous thromboses.. 

Decubitus 

Peritonitis (simple).. 

with perforation 
Intestn'l hemorrhage 

Relapses 

Xeuraloia of toes 



.128 
,....9 
...26 



,..16 
..17 
,..68 
,..40 
.145 
,..30 
...20 
,..25 

4 

3 

...21 
,..10 



.21 



.9.5 



, 2.0 
, 2.2 
, 8.8 
, 5.2 
17.6 
, 3.9 
,2.^ 
, 3.2 
, 0.5 
. 0.3 
. 2,7 
. 1.3 



.11 
...1 
...1 
...4 



...9 
...6 



..4,9 
..0.4 
..1.4 
..1.8. 
..3.6 
..0.9- 
..4.0 

'.*.*2.*7 



...2 
...5 



.0.9^ 
.2.2. 



We now pass from ^Munich and the southern 
part of Germany to Stettin in the northern part. 
Stettin is the city where Brand lived and labored 
(and still lives) and where he could make his in- 
fluence felt not only by his writings but by ex- 
ample and personal contact. AVe might there- 
fore expect that here we ought to see also in a 
conspicuous manner the good results of the 
Brand method if any such it should have to 
show. The statistics of the typhoid fever here 
while not as complete and detailed as those of 
Munich are still of much value and very inter- 
esting, because we have figures from the period 



— 26 — 



l^efore the water treatment was employed and 
others from the period when the Brand method 
was carried out. 

Table IV. shows the rate of mortality and 
No. of cases and we can see that the typhoid 
fever prevailing in this locality was by no means 
of a mild type, the mortality reaching 37 and 
€oming down to 15 as the lowest figure. This 
table is also of interest because it again shows as 
did the Munich tables that a high morbidity, or 
a great No. of cases in a year go together with a 
low percentage* of deaths. Thus in 1853 when 
the highest number of cases is recorded we have 
a mortality of 18.5 per cent which is only one 
half of 37 the highest percentage on the list and, cu- 
riously enough the year having the smallest num- 
ber of cases, 48, has the high jDcrcentage of 31.2. 
I exclude the war year of 66. 

Table TV, 



Showing No. of cases, deaths, and rate of mor- 
tality in the military hospital at Stettin from 
1849—1866 (exl. 65^. 



Year 


No. of Cases. I'Xo. 

1 


of Deaths. 


Rate of Mortality. 


1849 , 


1 1 
73{ 22 


30.3 


1850 


78: 


37.2 


1851 


16l| 


38 


22.8 


1852 . 


19G 


32 


16.2 


1853 


21l! 


39 


18.5 


1854 . 


136| 


34 




1855 


^< 


17 


27.0 


18 50 


145i 


38 


2G.2 



27 — 



Table IV. — Continued. 



Year. 


No. of Cases. 


No. of Deaths. 


Rate of Mortality. 










1858 


176 


55 


31.2 










1860 


85 


24 


28.2 


1861 


83 


23 


27.6 


1862 


53 


15 


28.3 


1863 


48 


15 


31.2 


1864 . , , 


74 


20 


27.0 


1866 


36 


19 


47.3 












1970 


519 


26.3 



I now quote from au address by Dr. Strube 
held March 21, 1878 in the militar-arztliche 
Gesellschaft in Berlin. ''This enormously high 
rate of mortality sank in 1865 suddenly to about 8 
percent. In this year Herr OberstabsarztLoewer 
introduced the cold water treatment of Brand 
while at the same time he had a chance to treat 
his cases in tents. When then in 1866 on ac- 
count of changes in the professional personel and 
other abnormal conditions the cold water treat- 
ment was discontinued (it was the year of the 
Austro-Prussian war) out of 36 cases of typhoid 
fever 17 died = a percentage of 47.3. In the 
following year when Herr Oberstabsarzt Scheide- 
mann and amongst others I myself had charge 
of the medical wards, and the typhoid fever 
cases were again treated with cold water the rate 
of mortality was between 7 and 8 per cent a 
figure which remained constant for some years, 



— 28 — 



but was reduced still further in later years when 
the Brand method was carried out with greater 
thoroughness. In the year 1873 — 74, according 
to the sanitary reports, all the cases occurring in 
the garrison of Stettin, 21 in number recovered 
=a mortality rate of 0 per cent. I have reports 
on an epidemic of typhoid fever raging in Stettin 
from November '77 to March '78, which furnished 
to the medical wards of the military hospital 66 
cases of typhoid fever. These were treated by 
Oberstabsarzt Kuhrt strictly according to Brand 
and Liebermeister and all the 66 cases recovered; 
here again we had a mortality of 0. per cent. 

Brand says that in the years 1867 — 82 there 
occurred in the Stettin military hospital 257 
cases w^th one death which also represent a mor- 
tality of less than 1 per cent. We see thus that 
here also the reduction of the death rate from 
typhoid fever has been unbroken and that it has 
decreased with the more thorough and systematic 
use of the cold water treatment. 

Of interest are further the reports of the 
second German Armee corps of which Stettin is a 
part. I again quote Strube: ' 'Through the kind- 
ness of the war department, I am able to make 
some communications on the typhoid fever sta- 
tistics of the second Armee-corps for the year 
1876 — 77 and wish to remark that in the major- 
ity of the hospitals the treatment is that of 



— 29 — 



Brand. During the winter a mortality of 7.2 
per cent and during the summer of 5.48 is re- 
ported, 7 deaths occurring in the latter period 
amongst 108 cases. But if from these seven 
deaths three are eliminated, viz.: one case in 
which adhesions were found due to former perito- 
nitis; one case where the post mortem examina- 
tion revealed acute miliary tuberculosis, and one 
case which was treated for 14 days elsewhere, with- 
out going to bed, the patient dying suddenly 2 
days after admission to the hospital, from profuse 
intestinal hemorrhage, there remains a mortality 
of only 3.7 per cent." 

The following table gives for one year, 
(1873 — 74?) the typhoid fever statistics of the 
whole army by Armee-corps, It is of the highest 
interest, because it shows the difference between 
the results w^here the method w^as carried out 
thoroughly and where not so thoroughly. Al- 
though it can be gathered from the reports that 
the w^ater has been employed in all the corps, 
yet in the second corps the water treatment has 
been carried out accurately after Brand's formula. 
I think the observations that can be made here 
have almost the value of a laboratory experiment 

The following facts also are worth mention- 
ing here. ''In 1866," Brand says, "during the 
war there died here, in Stettin, in the military 
hospital 48 per cent, (treatment without water); 



— so- 



under circumstances not any more favorable I 
have during the war of 1870 — 71 lost only 4.5 per 
cent of my soldiers, whom I treated with water." 
Table Y. 

Showing No. of cases of typhoid fever, deaths 
and percentage of deaths of Prussian army for one 
year ('73 — '74) in the different corps. 



Corps. 



XIII 

I 

YIII 

y 

lY 

Guards.. 
III.... 

IX 

X 

VII 

XI 

YI 

II 



No. of Cases. 



...19 
.132 
..,95 
,.139 
...91 
,.137 
...15 
,.138 
.171 
.238 
.237 
,.284 
.160 



No. of Deaths. 



Percentage 
of Mortality. 



...6.. 

.27!. 
.191. 
.24|. 
.17|. 
.22|. 
.11*. 
.181. 
.19i. 
.25L 
.25:. 
.24!. 
...6'. 



31.5 
, 20.5 
, 20.0 
, 17.2 
, ]6.4 
. 16.a 

. i4.e 

. 13.0 

. 11.1 

. 10.5 
. 10.5 
. ..8.4 
. ..3.7 



The preceding communication dates from 
1878. In 1887 Brand writes: ^'The mortality 
from typhoid fever in the second (Pomeranian) 
Armee-corps is of the highest interest. It amounts 
to 4.3 percent while the average mortality (from 
typhoid) of the whole German army is 8.3 per 
cent." 

We see that with the more thorough em- 
ployment of the hydriatic method the mortality 
in the whole German armv has been reduced 



— 31 — 



from 13.5 to 8.3, yet the second corps for reasons 
stated has still the best reports. 

According to Brand there died in the Pom- 
eranian military hospitals (second corps) in 



1882- 


-83 


out of 


477 


cases 


17 = 


3.56 


1883- 


-84 


( < 


429 




28 = 


6.53 


1884- 


-85 


t ( 


392 


( i 


14 = 


3.57 


1885- 


-86 


( ( 


188 




6 = 


3.19 



Brand exclaims: ^^A typhoid fever mortal- 
ity in the hospitals of ,the second corps (where in 
former years the very highest figures prevailed) 
of 3.2 ! who would have dreamed of suck 
things?" 

(The year 83 — 84 with the higher mortality 
rate Brand looks upon as exceptional.) 

In the military hospitals of the second corps 
there occurred from 1882 — 85 2711 cases with 
117 deaths, a mortality of 4.3. 

I pass now to a consideration of the typhoid 
fever mortality of the whole German army. 
First however let us see what the mortality rates 
are in other armies. 

The percentage of deaths from typhoid fever 
(Brand) in the 

French army was (1882) 32.2 per cent. 
Italian (1874—78) 28.36 

Austrian ' 27.4 

English (1882) 23.8 



— 32 — 



^ ^According to Riecke (in Tripier and Bou- 
Teret) the average rate of mortality from typhoid 
fever in the Prussian army was from 1824 — 44 
was 25.8 per cent; from 1867 — 74 (excluding the 
war time) 15 per cent. From 1874 on there 
followed in the German military hospitals a more 
general use of the cold water treatment, and since 
then a remarkably regular decrease of the mor- 
tality. This can well be seen in the following 
table giA^ing the morbidity and rate of mortality 
of the Prussian army. 

The official sanitary report 1879 — 1881 
points out that the mortality has been reduced 
from 25 per cent to 8.3, thanks to the Brand 
method." 

We cannot be surprised then if 14 of the 
Generalarzte of the Armee corps have ex23ressed 
themselves in favor of making the method ob- 
ligatory. 

Table VI. 



Oiving morbidity and rate of mortality in Prus- 
sian army from 1874 — 1880. 



Time. 


Xo. of Cases. 


Deaths. 


Rate. 


1874 


2735 


329 


12.0 


1875 


3620 


408 


10.9 


1876 


/ 2747 


298 


10.8 


1877 


2081 


206 


9.8 


1878 


2112 


190 


8.9 


1879 


1741 


163 


9.4 


1 8H0 





'^?6 


8.9 







— 33 — 

While a redaction of a mortality from 25 
per cent to 8.3 per cent would seem very satis* 
factory to most people, Brand, recognizing the 
fact, that in the second corps the mortality is 
only I of that the rest of the army, is not so well 
satisfied. Discussing this matter he says: ''I 
know, however, as well as any one else, and per- 
haps better, that not all of the military physi- 
cians by far, carry ont their treatment according 
to my directions, that, with the exception of the 
second corps, the confusion in their views and 
their methods of treatment, is as great as amongst 
the general practitioners. How various the 
treatment is carried out, I have described more 
accurately in the second edition of my mono- 
graph. Inasmuch however as the statistics of 
the hydriatic treatment only suffer on this ac- 
count, nobody will object to insert the high 
figures of the military hospitals into the statis- 
tiss." 

The preceding figures from the military 
hospitals referred to times of peace only. In 
the war of 1870 — 71 there was occasion to give 
the method a trial under other conditions. As 
might be expected, the mortality under medical 
treatment was exceedingly high in those years. 

In Paris 60.8 per cent. 

Around Paris 27,0 per cent. 

3 



In Rouen. 

InVigny (?) 



38.4 percent. 
18-1 per cent. 



The average was (excluding Paris) 27.8, in 
the Bavarian Army 24.1. 

The following figures are those obtained un- 
der the hydriatic treatment. 

Strube reports a mortality of 12.9 per cent. 
Schonheider 3.6 
Weidner " 6.5 

The number of cases was 508, the number 
of deaths 44 — a mortality rate of 8.6 per cent. 

Taking the results from all the reports, 
(cases treated in France and Germany during the 
war) it is found that there were treated 1308 
cases with 149 deaths == a mortality rate of 11.4 
per cent to be compared with 27 and 24. 

The results so far communicated obtained 
under the hydriatic treatment have all been ob- 
tained from German physicians and German 
patients. Let us now pass to France to see 
whether we shall hear of similar reports there. 

Brand, in his essay: On the present status of 

the hydriatic treatment of typhoid fever has a 

number of interesting passages, telling how the 
method was introduced there, how it gained 
friends, how it is carried out, what our colleagues 
there think of it and what they are doing in this 
matter. 



^ m ^ 

'^Surveying the literature (on the hydriatic 

treatment of typhoid fever) one will be 

surprised to notice, that the center of gravity of 
the hydriatic treatment of typhoid fever, wish- 
ing to have understood once for all by this the 
method as advised by myself (Brand) has been 
transferred from Germany to France, or more 
correctly to Lyon. Amongst 58 communications 
28 were written by French authors." 

''It does not take long to find a reason for 
this. While up to the first years of the seven- 
ties there was a rather close adherence to my di- 
rections and it w^as the systematic water treat- 
ment which was carried out. German observers 
have in the last ten years not been able to resist 
the inviting but erroneous idea that all that was 
necessary for the cure of typhoid fever, w^as to 
keep down the temperature, especially as the 
antipyretic remedies increased not only in num- 
bers but also in promptness of action. My w^arn- 
ings in my monograph (p. 21) as w^ell as in the 
article Salicyl or water treatment? (Deutsche 
militararztliche Zeitschrift 1876. 6) has re- 
strained but very few physicians from leaving 
the hydriatic method and adopting the antipy- 
retic method. And during the prevalence of the 
antipyretic rage nobody has had time nor inclina- 
tion to develop the hydriatic method further." 

''In France matters are different. In Lyoii 



typhoid fever is endemic, the rate of mortality is 
considerable (20 — 25 per cent) and on that ac- 
connt it was to be expected that the Brand 
method introdnced by Francois Glenard, who 
had become acquainted with it as a prisoner of 
war, was received favorably. In the beginning 
there was no lack of adversaries, in fact the 
physicians of Lyon were divided into two camps, 
the ^^Brandites" and ''Non-Brandites", but the 
tireless exertions , and the power of the facts and 
conviction finally succeeded in the course of time 
to win over all the physicians of Lyon, with a 
few exceptions, so that Gnoux (Le traitement de 
la fievre typhoide a Lyon en 1886) could write: 
''Typhoid fever is the one of all the febrile 
diseases, which we fear the least. When once 
a case is being bathed, wx neither apprehend 
surprises nor look for complications, we prefer 
it a hundred times to the whooping cough and 
even to the measles. In one w^ord as Glmard has 
expressed it, we have the disease in our hands, 
and if there were a proof lacking of our convic- 
tion, there could be no better one offered than 
that if we, physicians, or one of our family, are 
affected by a febrile disease, it is typhoid fever 
which we prefer, and our whole care is to inter- 
fere early enough with the baths. One will look 
around in vain to be able to cite a physician of 
Lyon, who will act otherwise in his own case, 



— 37 — 



or that of his wife, or his children, and in the 
heavy tribute which medicine (the profession) in 
Lyon has paid to typhoid fever during ihe last 
12 years one will look in vain for a case not 
proving successful. Finally, this practice of 
the physicians is known through the declaration 
of 1883, where they testify that they use the 
Brand method in their own families, in their 
private and hospital practice." 

^^A better testimony has never been given 
to support the therapeutics of a dangerous 
disease, as long as scientific medicine has been 
in existence, and the fact that it was given in 
1886, and in France, certainly does not detract 
from its value; I think it even does honor so 
much more to him who has given it, as to its au- 
thor." 

After treating of some other matters, Brand 
continues: ^'As has been remarked, Mr. Glenard 
became acquainted with the method while as a 
prisoner of war he acted here as my assistant in 
1870 — 71, and soon after his return had occasion 
to practically demonstrate the same to his col- 
leagues in Lyon. When in 1873 an epidemic of 
typhoid fever broke out there, he described the 
method in the "Lyon Medical" in its main features, 
and treated in the Hospital de la Croix Kousee un- 
der the eyes of many physicians, 51 cases, losing 
but one which came under treatment in a late period 



— 38 — 



of the disease. On the strength of a report by 
Mr. Rollet the procedure Avas adopted as ^vell 
in private practice as in the other hospitals of 
Lyon, but under the false presumption, that it 
was adapted only to the grave cases. Neverthe- 
less the result was a satisfactory one Glenard 

however is not a man who would allow these er- 
roneous notions concerning the method to pre- 
vail. A man of scientific and general culture, 
highly gifted and energetic, mighty with pen and 
speech, self-sacrificing, faithful, and polite, he 
made. all exertion to be, as he had j^romised, a 
champion of the Brand method in his home. He 

has more than kejDt his promise 

In a series of articles for journals which ap- 
peared also as pamphlets he has delivered the 

method in a short, j^recise, and elegant style, so 
that the translation of my monograph was su- 
perfluous and the majority of the physicians of 
Lyon became adherents of the method. As a 
proof of this statement I may mention the fact 
that when Dujardin-Beaumetz in the Academie 
de Medecine s^Doke of the method as useless and 
abandoned, of 24 clinicians and hospital physi- 
cians 22 subscribed to the following declaration: 
''The hospital physicians declare themselves par- 
tisans of the method of Brand in the treatment of 
typhoid fever, convinced that the method regu- 
larly applied from the beginning of the disease 



39 — 



will reduce considerat)ly the rate of mortality. 
They testify that they employ the same in their 
own families, in their hospital service and in 
their private practice." 

AVith this declaration Glenard went to Paris 
and had Mr. Bouley lay it before the Academic 
where, of course, it called forth a great storm." 

But Glenard has not only succeeded in con- 
vincing his fellow citizens of the soundness of the 
principles of the Brand method, especially re- 
garding its proplylactic importance, but also 
(and this is of the highest importance) to save 
them from starting out on the wrong way of an- 
tipyretics. In Lyon the accepted treatment is 
that of Brand, and all the variations and abnorm- 
alites of the water treatment, such as are cus- 
tomary in Germany, are unknown there." 

On the basis laid down by Glenard, Tripier 
and Bouveret have produced a work, an honor 
to themselves and a blessing for the whole world 
— provided that it will find readers, who will fol- 
low the directions it contains, which has not been 
the case with my monograph in Germany. Both 
professors, clinicians, and hospital physicians 
at the same time, have tested — sine ira et studio 
— the various points of the Brand method with 
the aid of a rich material and have published 
their results in a monograph entitled: La fievre 
typhoide, traitec par les bains froids, 1886, Paris 



— 40 — 



Baillere et fils. Although 635 pages in length 
this excellent work does not contain one super- 
fluous word. The problem which the authors 
undertook to solve was an unusually difficult one. 
It was not so much the point to demonstrate that 
the mortality of typhoid fever was less under 
the hydriatic treatment, than under any other — 
this has been done by others so often, that it re- 
quires no further proof; the main aim of the au- 
thors was to examine (1) whether the indi- 
cation Avhich has been laid down by me is the 
right one. (2) whether the treatment fully meets 
the indication. (3) whether the evidence which I 
have presented will bear a closer examination, 
and whether the conclusions based upon them are 
correct . 

Following such a plan only could they hope 
to attain their purpose, to make it possible to the 
medical profession everywhere, to form an opin- 
ion on the value and nature of the water treat- 
ment, and to learn to adopt and carry out the 
method in practice, without being in danger of 
being obliged to desist from using it in the case 
that difficulties should arise, or in discussions 
to make statements, which are at variance with 
all physico-phyiological relations. 

That such a labor cannot be set forth in a 
few pages is self-evident. This aim Iwwever they 
have reached in a brilliant way." 



— 41 — 



After listeuiiig so far to Braud on ihe for- 
tune of his method in France, let us see what 
French observers have to say. I select the ex- 
perience in the Hopital de la Croix-Rousse^ and 
quote Tripier and Bouveret." The statistics of 
the Hopital de la Croix-Rousse begin in 1866 
and end in 1885, the years of the war, however 
(1870 — 71) being omitted, it comprises a period 
of 18 years only, we divide this period according 
to the method of treatment into 3 periods. 
Every period is so long that the objection of 
epidemics of variable malignity does not hold 
good . ' 

I. The first period extends from 1866 to 
1872, during which cool baths have not been 
thought of. All typhoid fever cases were treated 
with medicines or expectatively exclusively. 
Under this treatment out of 229 cases 60 died, 
yielding thus a mortality of 26.20 per cent. 

The following table gives the No. of cases of 
typhoid fever, the No. of deaths and the rate of 
mortality per cent. 



1866, 33 cases, 


10 deaths, 


30.30 per cent 


1867, 62 " 


17 " 


27.41 


1868, 40 •' 


11 " 


27.50 


1869, 56 " 


14 " 


25.00 


1872, 38 " 


8 " 


21.05 



The annual mortality and the mortality of 
the five years together, arc about equal to the 



— 42 — 



average mortality of our hospitals before the in- 
troduction of the hydriatic method. This can be 
estimated as 25 per cent. 

The years of 1870 — 71 show in the Hopital 
de la Croix-Rousse a very high mortality: 

1870, 69 cases, 37 deaths, 53.62 per cent. 

1871, 38 18 47.36 
Adding these 2 years to the 5 

of our first period the mortality rises to 34.22 
per cent. As a matter of course, this relation, 
brought about by a great number of cases of un- 
usual gravity does not afford a correct notion of 
the average mortality from typhoid fever in the 
Hopital de la Croix-Rousse. We have therefore 
excluded these two years. From our standpoint 
the exclusion is not altogether justified. If the 
ordinary method of treatment shows its impo- 
tence in grave epidemics, this is not the case with 
the hydriatic method. Even under such the 
same is able, if applied systematically, to reduce 
the mortality quite considerably. 

II. The second period comprises 9 years 
from 1873 to 1881, during which 104 patients 
died out of 629, the mortality being 16.53 per 
cent. The decrease in the mortality is indeed 
quite remarkable: 26.20 per cent in the first 
period, 16.53 per cent in the second, which 
means a reduction of the mortality of one- 
third. 



— 43 — 



In the second period the Brand method was 
not carried out systematically. It was the rule 
to reserve it for the graver forms of the disease. 
A number of cases of medium gravity was not 
treated at all according to the method of late 
only, or after other medication had been em- 
ployed without any result. The patients were 
not always treated from the day of their admis- 
sion on, and not until grave symptoms appeared, 
did the attending physicians make up their 
minds to combat them with cold water. To con- 
clude Ave have been guilty of yielding to the in- 
clination, to make the method milder and more 
rational and to individualize, which always shows 
itself when the first exj^eriments with the hydri- 
atic method are made, which accounts for the 
application in many of the cases of combined 
methods (baths and medicines) and incomplete, 
defective and insufficient cold water procedures. 
Hence the annual mortality in this second period 
is very variable, at times very loAV, at times 
high relatively, as can be seen from the following 
table: 

1873. ..44 cases 11 deaths 25. 00 per cent. 

1874.. 142 22 15.49 

1875. ..44 5 ; 11.3(3 

1876. ..50 14 28.00 

1877. ..43 8 18.60 

1878. ..47 8 17.01 



— 44 — 



1879... 36 cases 
1880. ..81 , 
1881. .142 " , 



6 deaths 
6 



16.66 per cent. 

7.40 
16.90 



24 



The first experiments of Glenard date from 
the year 1873 ,, in which year the water^ treatment 
was adopted for the first time in Lyon in the 
Hopital de la Croix -Rousse. In this year the 
mortality was 25 per cent. The remark how- 
ever must be made that the method was em- 
j^loyed in the second half of the year only and 
only in the ward St. Pothin, the division of 
Faivre, whose assistant Glenard was at that 
time. The first experiments of Glenards were 
successful. Nevertheless the method was not 
accepted without contradiction and modifications, 
At the end of 1875 and particularly in 1876 a 
reaction occurred not only in Croix-Roussee but 
in all the hospitals of Lyon, against w^hat was 
called rigorisme, and Brand's absolutism; these 
years therefore show a stand still in the decrease 
of mortality. 

III. The third period extends from 1882 to 
1885 inclusive. For the last year those cases only 
are reported, which had recovered at the time of 
the publication of this book." 

This period contains 260 cases with 19 
deaths, making a mortality of 7.3 per cent. 

The annual averages vary far less than in 



_ 45 - 



the prececding period, they are all below 10 
per cent. 

1882 80 cases 4 deaths 5.00 per cent. 

1883 46 2 4.34 

1884 62 6 9.67 

1885 72 7 9.72 " 

The decrease in mortality in this period is 
considerable compared with the first: 26.2 per 
cent ; it amounts to less than one-third of the 
same. Thus the mortality from typhoid fever 
has been reduced two -thirds. 

Shall we call in a Genius epidemicus as has 
often been done, to explain this striking de- 
crease? Never before the introduction of the 
cold water treatment has the mortality from ty- 
phoid fever been as low as in the Hoj^ital de la 
Croix-Rousse. During the whole of the first 
period from 1866 to 1872 the lowest annual mor- 
tality has been 28.05 per cent. Are there any 
where hospital statistics in existence with 260 
cases extending over a period of four years, cer- 
tainly long enough to meet the objection as to 
the benign character of the type of the epidemic 
having brought about the results, — are there 
statistics in existence which under medical or ex- 
pectative treatment show a mortality of 7.3 per 
cent ? 

Since 1882 the head physicians, who have 



4^ ^ 



succeeded each other in the medical division of the 
Hopital de la Croix-Rousse have come back 
definitively to the pure method. Some use it in 
all the cases without exception, others exclude 
the mild ones. AYe do not wait for any indi- 
cation in ordering a cold bath. When no con- 
tradictions exist, the typhoid fever j^atient is 
bathed as soon as possible after his admission or 
at the latest on the following morning. When- 
ever the fever is of any considerable intensity, 
the internes institute the method, without wait- 
ing for the visit of the head physician. We 
make all exertions possible to raeet the two fun- 
damental indications to bathe from the very be- 
ginning, and to bathe as many cases as possible. 
There is left but one j^f^r?^ desiderium, that all 
the typhoid fever cases might come under our 
care before the end of the first week. Although 
we know, that our colleagues in the quarters of 
de la Croix-Rousse send us their patients as soon 
as possible, it is not ahvays possible to overcome 
at once the scruples of the patients and his 
friends, when the word ^^lospital" is mentioned. 
This delay is the cause of many failures. Thus 
the somewhat higher mortality of the years 
1884 and 1885 is explained by the circumstance 
that cases of a grave character or presenting 
complications or being in an advanced stage of 
the disease were brought to us." 



Placing the 3 periods of the statistics side 
by side we obtain the following: percent. 

I. 1886—1872, 229 cases, 60 deaths, 26.20 
II. 1873—1881, 626 104 16.90 

III. 1882—1885, 260 " 19 7.30 

These results are almost identical with those 
of Liebermeister, who obtained in his first period 
of his statistics a mortality of 27.0 per cent, in 
his second of 16.2 per cent and in his third of 
8.8 per cent. 

In the statistics of the German military hos- 
pitals we find these three periods. Before the in- 
troduction of the method they had a mortality of 
25.80 per cent in the second period, from 1868 
to 1874 15 per cent and after that as the Brand 
method made progress it sank to below 8 . 9 per cent 
for the whole German army. Is this not a glaring 
proof that the prognosis in typhoid fever does 
not depend on the character of the epidemic but 
upon the prevailing method of treatment ? 

This fact may be placed alongside of the 
marked diminution of mortality since the intro- 
duction of antisepsis in surgery. This import- 
ant fact not only from a scientific but also from 
a humanitarian standpoint — it must be said — is 
passed over in silence in the latest public statis- 
tics." Dr. Bouveret informs me by letter that they 
had treated in a hospital during the last two years 
100 cases wit but three deaths. 



— 48 



Every general practitioner is particulariy 
interested in children's diseases — children form- 
ing the bulk of his patients; it will therefore be 
of interest to follow the method amongst this 
class. The general verdict seems to be that per- 
haps on account of the less deep lesions in the 
alimentary canal in children, the j)rognosis in 
their case is better than in adults; thus Murchi- 
son gives the mortality as amounting to 11.14 
per cent amongst males, and 13.86 amongst fe- 
males between 5 and 14 years of age. But that 
the results are not always as favorable may be 
seen from the facts that Bathez and Rilliet re- 
port 111 cases with 29 deaths (27 per cent) and 
in Paris in 1854 amongst 260 cases, 68 deaths 
occurred (26.15 per cent) in children under 15 
years (see Murchison) and Caijla (T. and B.) re- 
ports that amongst 81 children treated in a period 
of four years in the Gharite at Lyon 28 (34.5 
per cent) have died. Such facts would seem to 
point to the view, that perhaps tyyhoid fever is 
after all more dangerous to children than the 
prevailing opinion would admit. Inasmuch how- 
ever, as pathological anatomy proves that the in- 
testinal lesions are less profound, in their case, 
we might expect, inasmuch as death here must 
be largely due to the fever that we should see 
particularly good results from the method and such 
seems to be the case as shown by the following 



— 49 — 



Table 

Showing the result of hydriatic treatment 
amongst children. 



Reporter. 


No. Cases. 


No. Deaths. 


Percentage. 




28 


1 


3.5 




63 


4 


6.3 




106 


0 


, 0 










Total 


197 


5 


2.5 



After giving reports from special places let 
us now look at the total results obtained under 
the use of the method. Before reviewing these, 
however, let us glance at figures showing the re- 
sults under medicinal treatment. 



Table YIII. 

Showing death rate under medicinal treatment of 
8296 cases of typhoid fever. 



Observer. 



Liebermeister 

Griesinger 

Juergensen 

Wunderlich 

Mil.Hosp.8tettin49-59 

Hamburg Hosp 

London fever Hosp 



. Total 8296 



..1718 
...470 
...330 

,.1178 
,.1591 
...504 
,.2505 



469 

89 

51 

213 

405 

96 

465 

....1788 



...27.3 
...18.9 
...15.6 
...18.1 
...25.6 
...19.0 
...18.5 

...21.7 



— 50 — 



Table IX. 

ShoAving death rate luuler medicinal treatment of 
24,997 cases. 



Place. 



i 



1 Leipzig Jakobs Hospital 600 Ill 18.5 

2 Bethanien (Berlin) 301 55 18.0 

3 WiedenerKrauk. H.Wien 928 171 18.4 

4, The same 1871 449 91 22.4 

sLlllg. Krauk. Hans Wien 17651 3973 22.5 

6 Dresdener Krank. H 1497 13.1 

7 Chomel Paris 147 47 32.0 

8 Torge? Strassl)urg 190 44 23.1 

9 Paris 1854 4611 1002 21.7 

10 Molard Metz 120 31 26.3 



... Total 24997 5525 22.2 

In is 77, Brand, in the second edition of his 
Monograph ^^Die Wasserbehandlung der ti/phdsen 
Fieher, ' ' Tuebingen, 1877, LauppscheBuchhand- 
Inng, published the statistics of 8141 cases, Avhich 
being also a large number, may be fitly used to 
compare with those just given. I will premise, 
however, that amongst the 69 observers perhaps 
two-thirds only carried out the treatment with 
some approach to Brand's method; the remaining 
one third did use water also, but only in combi- 
nation with other drugs and, to state the matter 
in simple language, very sparingly and insuffi- 
ciently, the results being 6.0 per cent mortality 
in the former category, and 13.5 per cent mortal- 



— 51 — 



ity when deviating less and 15.8 per cent wlien 
deviating more from the systematic method, with 
variations between 0. and 25 per cent. Great vari- 
ations in the result always indicate an inadequate 
application of the method, and it can always be 
seen that the correct application will keep the 
mortality down to a uniformly low level, be the 
character of the epidemic what it may. 

Table X. 

Giving an epitome of the large statistics of 
Brand of 1877, the death rate of 8141 cases, un- 
der hydriatic treatment. 



Source. 


No. Cases. 


No. Deaths. 


Percentage. 


Private practice 
Children pract. 
Civil Hospitals. 
Militarv Hosp.. 


689 


14 


2.0 


197 


5 


2.5 


4733 


318 


6.7 


1214 


114 


9.4 


War Hospitals.. 


1308 


149 


11.4 


Total 


8141 


600 


7.4 



Table VIII. containing about the same num- 
ber of cases will therefore fitly be compared: 

Per cent. 

Medicinal treatment yields a mortality of 21.7 
Hydriatic ^ " ^'"^ 7.4 

The water treatment tlius diminishing the 
mortality two-thirds. 

In 1887, Brand published some articles en- 
titled '^Ueher den heutigen Stand der Wasser- 



— 52 — 



behandlung des Typhm,'' in which he makes some 
additions to the figures above given, which may 
be seen by the following table. 

Table XI. 

Showing the gross results of the hydriatic treat- 
ment up to 1887. 



1. Up to 1877 

2. Military Hospitals... 

1877^. 

1878 

1879 

1880 

3. Mil. Hosp. II. Armee 

Corps 

1882— 83 

1883— 84 

1884— 85 

1885— 86 

4. Juergensen(Tuebin- 

gen) 

Vogl (Muenchen)... 
Tripier and Bouveret 



Total. 



Xo. Cases. No. Deaths. Percentage. 



.8141 



.2081 
.2112 
.1741 
.2534 



,.477 
..429 
..392 
,.188 



..220 
..221 
..481 



..600 



,.206 
,.190 
.163 
,.226 



.17 
.28 
.14 
...6 



...4 
...6 

.29 



.19017' 1489 



.7.4 



.8.9 
.9.4 
.8.9 



.3.5 
.6.5 
.3.5 
.3.1 



.1.8 
.2.7 
.6.0 



''Amongst these 19,017 cases," Brand adds, 
•'there are all forms of typhoid fever, all pri- 
mary and secondary complications, all ages, both 
sexes, epidemic and sporadic, benign and malig- 
nant cases, hospital and private j^ractice, civil 
and military practice, peace and war, everything 
is represented, that might influence the course of 
typhoid fever. We have here an exhaustive and 



— 53 — 



complete synopsis, and if (what might have easily 
been the case) all observers had strictly adhered 
to my rules and carried out the systematic treat- 
ment, as Vogl, Tripier and Bouveret have done, 
these statistics and their result would be una- 
vailable. But under the circumstances this is 
not the case. Some have followed Lieber- 
meister's old or new method, some Ziemssen, 
others again Juergensen and myself, the most 
have followed a method of their own. All these 
methods have in common the application of 
baths, and so far they may be classified under 
the hydriatic method. But inasmuch as only in 
the cases treated after the Brand method all the 
requirements of the systematic water treatments 
are satisfied, in the rest, however, only those of 
the antipyresis, (i. e. that in the former all parts 
of the fever-process are combated, in the latter, 
however, merely the rise of temperature) it fol- 
lows that the above statistics do not give results 
of either one or the other method of treatment, 
but of both together, i. e. Bjmixhtm compositum, 
and that as a general result merely, it can be 
said, that where water is employed in the treat- 
ment of typhoid fever the mortality will gener- 
ally be lower, than where it is not employed. 
Taking large figures the hydriatic treatment at- 
tains about one-half or one-third the percentage 
of mortality that the expectative method does. 



- 54 — 



the former about 8 per cent, the latter 15 — 20 
per cent." 

Brand, selecting the observers that have fol- 
lowed his method systematically, finds that out 
of the 19017 cases, 5573 cases have been treated 
with 234 deaths = mortality of 3.9 per cent. 

We now come to the sixth question: What 
results have been obtained by the method when its 
execution is perfect f 

''From statistics/' Brand says, ''which are 
available for such purposes, we have to de- 
mand : ' ' 

(1) That the number of the cases observed 
be as large as possible, many hundreds. 

(2) Their collection must cover many years. 

(3) All ages, sexes, stations of life, all con- 
stitutions, temperaments must be liberally rep- 
resented. 

( 4) All possible primary complications must 
have occurred. 

(5) The cases must have come under treat- 
ment early or at the right time, and the treat- 
ment must have been carried out systematically. 

"As a matter of course not many such cases 
can be gathered." 

"Reports from civil hospitals cannot be used, 
because patients come there in a late i)eri()d of 
the disease and are dismissed too early to exclude 
the development of secondary troubles, nor from 



— 55 — 



cliuics which get their material from such hos- 
pitals for the same reasons. 

The most useful material can be furnished 
by family practice in cities, where the physicians 
duty is not only to treat any sickness which may 
have occurred, but where the cure and develop- 
ment of the body of his patients are the object 
of the physicians attention. Here he knows 
every member of a family, hears of the very 
beginning of any sickness, is able to observe and 
treat the case accurately and to keep the patient 
under observation after recovery. 

Reports from policlinical practice and general 
practice can be utilized to a small degree only. 
Those obtained in country practice (Brand has 
however, German conditions in mind) not at all. 
An exception to this rule can be found in Juer- 
gensens policlinic in Tuebingen. 

With the highest interest I have convinced 
myself on the spot, how this ingenious scholar 
and physician has understood to create for him- 
self, in the village of Lustnau near Tuebingen, a 
policlinical territory, and I have observed the high 
respect and esteem which is shown him by the 
inhabitants. Everybody knows him, and like- 
wise he knows everybody. He can justly be 
called the ^'family physician of Lustnau". The 
result of his activity therefore meets the highest 
requirements and demands. 



— 56 — 



Of the highest value are some of the reports 
from military hospitals. Soldiers generally come 
under observation in an early period of the 
disease, and remain under observation for the 
detection of any sequelae. The mortality amongst 
them is a high one, hardly less than that of per- 
sons more advanced in years. They are there- 
fore valuable subjects for testing the specific 
treatment (>f typhoid fever. 

To ascertain correctly, therefore, the true 
rate of mortality of the systematic water treat- 
ment, there are only suitable out of a great num- 
ber of reports, the following : 
Juergensen, Tuebingen, 217 cases, 1 death. 
Vogl, (Muenchen) 221 6 deaths. 

Milit. Hosp. Stralsund, 1877-82, 257 1 death. 

Stettin, 1877-82,186'^ 3deaths. 
Brand (family practice) haus-arztliche Praxis, 

342 - 1 death. 

Total 1223 cases, 12 deaths and 1 per cent mor- 
tality. 

It must be added that three cases of Juer- 
gensen are omitted, these not having been treated 
with water. 

Although amongst the Pomeranian military 
hos2Ditals there are others with a minimum mor- 
tality from typhoid fever, only those of Stral- 
sund and Stettin have been utilized, the former 
because the figures can be inspected in the 



— 57 — 



official sanitary report, the latter because the 
observations have been made, so to speak, under 
my eyes." 

'^My own 342 cases have been collected in 
the course of 30 years in a city where a grave 
form of typhoid fever is prevalent, as can be seen 
from the statistics of the military hospital given 
above and from the history of cases which I have 
published. Taking into consideration the small 
number of cases, one may conclude that every- 
thing has been thrown out which was not gen- 
uine typhoid fever. One may be convinced that 
all primary complications as well as all shades 
and forms of the disease are represented in this 
number. 

These 1223 cases then would seem sufficient 
evidence, and the true rate of mortality would 
therefore be 1 per cent." 

This rate of 1 per cent Brand even thinks 
too high, inasmuch as none of those 12 cases 
which ended fatally, received systematic treat- 
ment before the fifth day. 

Having these figures before us, what answer 
shall we give to the question: Are we justified 
in using the cool bath treatment of typhoid 
fever? I, for my part, would answer, that I am 
not only justified, but I feel as though I did not 
do my duty to my patients not to propose this 
mode of treatment, and have done so for over a 



— 58 — 



year, in private practice, about which I shall add 
a few words at the end of the volume. 

Of course the objection may be made, that 
the evidence here offered is of the jjost hoc — 
ergo propter hoc kind. Those who make this 
objection I should like to ask on what sort of 
evidence do they use quinine in malarial attacks, 
mercury and jodide of potass in siphylis, iron 
against chlorosis iodine against goitre — vaccinate 
against smallpox. 

Have they an insight into the nature and work- 
ing of the malarial poison on the one hand, and a 
knowledge of the molecular structure of quinine 
on the other hand, that they can offer scientific 
reasons for the employment of quinine? If there are 
any such reasons I have never heard of them . Yet 
what is considered as a more certain therapeutic 
proposition than that quinine w ill check intermit- 
tent malarial attacks. Xothing of course is more 
difficult than to judge of the value of any thera- 
peutic measure. But in many cases we are satis- 
fied with the post hoc. viz. when the exhibition 
of some remedy and improvement in the patient 
occurs so regularly, if not uniformly, under all 
possible conditions, and in the^course of a num- 
ber of years, — then our logic compels us to bring 
the two facts into connection. 

In the present case we have the results not 
in the practice of one man, but of dozens of ob- 



— 59 — 



servers, we have not only the originator, who 
might be expected to be carried away by enthu- 
siasm, but by able men, practitioners and teach- 
ers, who are able to judge ; we have not a series 
of recoveries out of a lucky year, when the 
disease was of a mild type, but the observation 
has now been carried on for 30 years; the results 
of this treatment do not vary with the gravity of 
the epidemic, but with the thoroughness of the 
therapeutics; the mortality rate wherever the 
method was introduced, was at first high, as the 
method was not carried out systematically, but 
steadily sank to a uniformly low level, together 
with the improvement of the treatment; we find 
the same result not only in north Germany but 
also in the south, not only in Germany but 
also in France. 

But we have other evidence to offer for the 
value of the method in studying the effect on the 
symptom of the disease and the function of the 
body, which will be done in the next chapter. 

Here it might be in place to discuss a topic, 
which in practice we will be able to meet, 
especially when we wish to introduce the method 
in a community where it is unknown. When we 
shall suggest the method, the patient, if he is 
conscious, or his friends, will be very apt to ob- 
ject, and will ask whether the metliod is not a 
very dangerous one. Happily we can tell them 



— 60 — 



that there is no danger at all. I can say that I 
have had about 1500 baths given to patients from 
19 months of age up to 40 years, and amongst 
those no incident occurred which gave any alarm; 
but my experience is small. Let us ask others. 
Vogl says: (Deutsch. Medc. AVochenschrift 1888. 
48. 49). ^^The objection to the cold bath on ac- 
count of the danger connected with it has been 
silenced, after the thousands and thousands of 
baths that have been given in Germany and 
France, have with but very rare exception been 
followed by no accidents, and in the Miinchener 
Medic. Wochenschrift No. II. 1889 we read : 

^^We could ascertain after an experience of 
thousands of baths that a cold bath of 15° or 14° 
R — even 12 R (66 to 60 F) was absolutely with- 
out danger to a feverish patient of a normal con- 
stitution, and that it may be used when high fever 
is present, even if the diagnosis of typhoid cannot 
as yet be made, and we can affirm that the contra, 
indications, which to us as well as to other be- 
ginners misinterj)reting certain effects of the bath 
as heartweakness, were great hindrances, can be 
reduced to a minimum." 

Of course the small, hardly perceptible pulse, 
the shivering, the cold hands and feet — symp- 
toms lasting perhaps 15 — 20 minutes after the 
patient has come out of his bath, will make 
the physician, who makes his first trial, feel a 



— 61 — 



little uneasy and may alarm the attendants, but 
soon both physicians, friends and nurses will see 
that these conditions are not ominous, and will 
feel perfectly quiet. 

While we can confidently allay all fears as 
to the danger, we cannot say that the procedure 
will be a pleasant one to the patient in many 
cases, and of course there is some trouble con- 
nected w^ith the application of a number of baths, 
perhaps 8 — 12 a day in severe cases. But I think 
the patient will be doubly repaid for the un- 
pleasant sensation he may have on entering the 
bath and during the last part, and the shivering 
afterward, by 2^ hours and more of sweet sleep, 
and the avoidance of many other unpleasant 
symptoms. It will not be without interest to hear 
what Dr. Vogl has to ^ay on this point as one, 
who, on account of an attack of typhoid went 
through the experience himself, and who took 92 
baths during two w^eeks, in the first days of 14 R 
and in the last of 16° of 15 minutes duration, 
when the temperature was 39 C. in the rectum. 
He says: "To speak about the sensations which 
the bathing produced in my case, I will admit 
freely, that the stepping into a bath, always 
without aid, with a body temperature of 104, on 
account of the contrast, will produce the feeling 
of shock, which is difiicult to describe and by no 
means pleasant. But this lasts but a short time. 



— iVl ~ 



the cooling-ofP-process, which follows it, acts very 
pleasantly. It is not difficult to endure the pre- 
scribed 15 minutes. Xear the end of the time 
the longing for subjective warmth makes itself 
felt, and an extension beyond this time makes 
itself felt more unpleasantly than the shock upon 
entering the bath, if excessive also as more dan- 
gerous than *an excessive shock. A.fter the rapid 
but thorough drying there folloAvs in the 
warming of the surface of the body and to- 
gether with that an unestimable feeling of satis- 
faction (2So()l6eE)agen) and relief during an ex- 
ternal and internal normal temperature. There 
follows a longing for food and sleep, and during 
night a refreshing sleep which lasts the longer, the 
slower the temperature rises. 

In the first days o:^ the fever-acme the sub- 
jective unpleasant sensations make themselves 
felt during the last one-quarter or one-half of 
the two or three hours interval (but not any 
sooner) due to the fever then getting the upper 
hand, such as general discomfort, restlessness, 
and heat on one-half of the face and on the 
body, cessation of sleep, frequent respirations 
etc. 

These symptoms increase rapidly and ap- 
proach the condition of a deeply disturbed brain 
function, one feels himself near the confines of 
consciousness ; soon the first indications of de- 



— 63 — 



lirium and lialliicinatioiis show themselves 

the taking of the temperature shows the high 
fever and furnishes the indication for a bath, 
which one submits to with more willingness, 
inasmuch as one cannot be in doubt concerning 
the further increase of the symptoms without a 
bath. Kor does one hesitate to bathe even when 
the 39 degrees have not been reached in order 
to feel well for 1^ to 2^ hours. Under such ob- 
servations the fever took its course without com- 
plications as I am accustomed to see it with my 
patients. 

With such a strict execution of the bath- 
treatment there was a chance to compare the sen- 
sations that are produced on the one hand by the 
cool bath itself and its effects, and on the other 
hand by the increasing fever-heat and its attend- 
ing phenomena. I can corroborate, what the 
observation of numbers of cases of typhoid fever 
before or after the introduction of the baths — 
has shown to me, that the patient who does not 
bathe suffers a good deal more than he who does, 
as long as his abnormal sensations affect his 
consciousness at all." 

Resume. 

The hydriatic treatment hns reduced the 
mortality from typlioid fever : 

(1) In Munich from 20 per cent to 6 per 

cent. 



— 64 — 



(2) 111 Stettin and II. German Army-corps 
from 26 per cent to 5 per cent. 

(3) In the Prnssiaii army at large from 25 
per cent to 9 per cent. 

(4) In some of the French hospitals from 
26 per cent to 8 per cent. 

(5) In the practice amongst children from 
11 per cent to 3 per cent. 

(6) Taking the largest numbers in con- 
sideration the mortality nnder ordinary treatment 
has been 22 per cent, while under water treat- 
ment it has been 8 per cent. ^ 

(7) Where the method was carried out the 
most systematically, the mortality has been re- 
duced to 1 per cent. 

(.8) The hydriatic method is not a dangerous 
procedure. 

(9) The hydriatic method is useful in com- 
bating anoying symptoms, and is only unpleasant 
for the patient when he has to step into the bath 
and during the last stage of the process. 



CHAPTER II. 



The influence of the hydriatic treatment on the different organs, 
functions, and symptoms. 

In this second chapter the influence of the 
baths on the temperature, on the organs of cir- 
culation, on the organs of respiration, and diges- 
tion, on the skin and the urinary secretion, on 
the nervous system and the general condition of 
the patient will be described. 

In this important chapter which is to demon- 
strate that the cool bath treatment is not simply, 
like antifebrin or the allied remedies, an antipy- 
retic remedy, but is able to influence the system 
in a marked and beneficial way otherwise, besides 
cooling off the patient momentarily, Tripier and 
Bouveret as well as Yogi will be given room to 
report on their experience. Any minor differences 
might be explained by the circumstance that 
Yogi's patients were soldiers who almost always 
came under observation soon after they were 
taken ill, while the observations of Tripier and 
Bouveret were made on persons of all ages and 
both sexes, who came under treatment in various 
stages of the disease. I think the uniform re- 
sults of the observation of different observers 

5 



— Be- 



speaks strongly in favor of the useful and reliable 
qualities of the method. 

Whether high temperatures are very dan- 
gerous to the organism or not, at any rate high 
temperatures and a dangerous condition of the 
typhoid-fever-patient are apt to go hand in 
hand, and it is not unreasonable to assume that 
the temperature indicates not only the condition 
of the heat regulating apparatus, but reflects also 
the condition of other nerye-centers and organs, 
the action of which is of the highest importance 
to the organism. The influence on the tempera- 
ture, Avhich the water treatment exerts, will thus 
always be an interesting and important study. 

Influence of the Baths on the Tempera- 
ture. 

The temperature during the hath. T. and B. 
haye made observations (by means of a ther- 
mometer, which could be wholly introduced into 
the rectum) on this question, and have found 
that as a rule a rise of temperature during the 
bath could be observed, that this rise might 
amount to 0.1 — 0.8° C, that it was apt to be 
higher at the beginning of the bath than at a 
later period, that it was more marked in cases, 
that were in the first stage of the disease, 
and in graver cases which in other Avays 
showed a great power of resisting the cooling- 



— 67 — 



down-process. A marked rise of temperature 
during the bath thus would be of some prognos- 
tic value, indicating that the case was not of a 
mild type. 

The temperature between the baths. ^'In the 
majority of cases there is observed a reduction of 
temperature after the bath, of a greater or less 
degree. Generally the maximum of this reduc- 
tion does not take place immediately after the 
bath. AVhen the patient is dried off and put 
back to bed., the temperature sinks further and 
reaches its lowest point 15, 20, 25, 30 minutes 
and even one hour later, remaining stationary 
here often but a short time, and then ascending 
more or less rapidly to the point before the bath 
and even higher." T. and B. 

To illustrate this matter T. and B. have 
drawn three curves (See Plate I). In the first 
the temperature has almost reached its former 
height in 1^ hours, in the second it has in two 
hours come within 0.4° C. of the former tem- 
perature without a tendency to rise further, in 
the third the ascent is a gradual one, requiring 
six hours before the former temperature is 
reached. 

Curve I. was taken from a grave case : 
atactic form with hyperpyrexia, 9th day of sick- 
ness, 1st day of treatment ; it shows the course 
of the temperature measured every 80 minutes, 



PLATE I 3 P.M. 





































































































— 














































\- 
















































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f 






































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r 

f — 






























































































































































































f 










































1 














































































































































f 


LU 

fy 






















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' J 


ZD 


c 

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V 
















































\ 
















































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.A 




































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* 




































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\ 














































































































































































































































































































































/ 

\ 


u. 




c 






> 


i 


- 










'y. 




7 


































































J 


1 














































V 
















































\ 
















































\ 
























c 


























V 














































fs 


\ 








J 






































u 


\ 








/ 








































\ 






















































f 










































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1— ■ 




















































































































c 


R 




i 


m 

































































Curot 3, 



— 69 — 



between the first two cold baths from 12 — 3 
P. M. 

Curve II. is taken from tlie same case but 
from a much later period. 

Curve III. is taken from a case of medium 
gravity admitted on the 22d day, the fever is al- 
ready under control ; for 4 — 5 days the patient 
is omitting baths, that is, his temperature does 
not reach 39.0° when taken every three hours." 

The following table of Ziemssen (Brand) 
shows the effect on the temperature under various 
conditions : 



Degree 
of Reduction. 


Children. 


Grown Persons. 


Mild Cases. 


Severe Cases. 


0.2 








0.3—0.5 


1 


11 


116 


0.6—1.0 




120 


434 


1.1—1.5 


8 


270 


837 


1.6—2.0 


6 


^9. 


9,70 


2.1—2.5 


3 


13 '54..... 


2.6—3.0 


8 


1 'l2 


3.1—3.5 


11 


0 '6 


3.6—4.0 


12 


0 0 


4.1—4.5 


5 


0 9 


4.6—5.0 


6 


0 0 









The following results have been obtained by 
these and similar observations : 

1. ^'The absolute effect of the bath is greater 
in the case'of children, than in the case of grown 
persons, less in grave cases of grown persons, 



— 70 — 



and Avheu the fever was of a subcontiniious 
type. 

2. The duration of the effect of the bath is 
more considerable in mild cases of grown per- 
sons, less with children and least in grave cases 
with high continuous fever. 

3. As the disease advances,, the absolute effect 
as -well as its duration is, as a rule, more pro- 
nounced, the subcontinuous fever only being the 
cause of exceptions.*" (Brand;. 

The average effect of the bath is in grown 
persons 1.3— 1.5° C. (about 2— 3° F.) in chil- 
dren 2.0—2.5° (about 4— 5° F.). 

The duration and the temperature of the 
bath are of importance on the reduction of the 
temperature. In the beginning of the bath the 
body defends its temperature against the cooling 
process, but after a while the bath gets the up- 
per hand. A chill at last sets in and at the same 
time the body-temj^erature begins to sink. This 
chill may occur in 5 — 6 minutes in mild cases, 
and in very severe cases without heart -weakness 
in 15 minutes, as a rule in about 12 minutes. 
The baths generally employed having a tempera- 
ture of 20° C. (68° F.) will generally produce 
the desired reduction of 1° C. (about 2° F.) but 
in some cases these results are not reached and 
water of lower temperature 18 — 15° ( 59 — 65° 
F. about) has to be employed. Similarly a })ro- 



— 71 — 



longation of the bath which generally is to last 
15 minutes, will produce a reduction which the 
usual batli of 15 minutes will not produce. 

Although mentioned above already it is im- 
portant to state specifically, that in a later stage 
of the disease the resistance of the fever to its 
reduction is not as strong as at an early stage 
and a considerable fall of temperature in this 
stage does not always indicate that the case is a 
mild one ; if a favorable change in other symp- 
toms does not take place at the same time it may 
show that the heart is beginning to fail and that 
a modification of the ordinary formula is indi- 
cated. 

The observations of the effect of the first 
baths is not without value as well as regards 
progiiosis as treatment. If the reduction of the 
temperature is but small, and the same has risen 
in a short time (1^ — 2 hours) to its former 
height, the chance is that we have a graver form 
of the disease to treat; if the reduction is suffi- 
cient, and particularly if the temperature is slow 
to go back to its former height, the chance is 
that v/e have a mild form, the latter to be an 
absolutely favorable sign, must of course be ac- 
companied by favorable changes in the pulse, 
nervous symptoms etc. Nor have liberal reduc- 
tions in a late stage the same happy significance 
as when occurring in an early stage. ^ 



— 72 — 



For method of treatment, likewise, the obser- 
vations on the effect of the first baths are of im- 
portance. If the ordinary formula, a bath of 
20° C. temperature and of 15 minutes duration 
should show itself insufficient after a trial of a 
day or two, then the treatment has to be carried 
out with more vigor. Vogl and Tripier and 
Bouveret increase the number of batlis, reducing 
their temperature, while Brand prolongs his baths, 
also reducing their temperature under such cir- 
cumstances. 

Further as will be pointed out, children re- 
quire shorter baths, and in persons of feeble heart 
in advanced stage of the disease the ordinary 
formula is to be modified ; either a short cold 
bath is to be employed, or cold offusions in the 
luke-warm half -bath. (After T. and B.) 

Modification of the thermometric curve. Al- 
though every case has its own peculiarity, yet on 
the whole the type of enteric fever is to rise 
gradually for 3 — 4 days, to remain at an even 
height in the neighborhood of 40° C. (acme) and 
at the end of the third or fourth week to descend, 
the morning tem23eratures descending lower than 
those of the evening. Has the cold water treat- 
ment any effect to change this typical course, or 
are the baths (as so many doses of antipyrine ) 
only able to cool off' the body as often as they are 
given*' I 'place alongside the average daily tem- 



— 73 — 



peratiire of a case of Wunderlich which I find in 
Murchison from the fourth to the thirteenth day, 
and those of a case treated hydriatically by Vogl 
which I find in an essay of Brand. 





Celsius. 


Fahrenheit. 


Wunderlich 


Yogi. 


AYunderlich 


Vogl. 


4th day.. 

5 


39.5 

40.1 


39.9 

39.4 

39.3 

39.2 


103.1 


103.8 


104.2 

104.6 

104.6 


103.0 


6 


40.3 


...102.8 




40.3 


102.6 


8 


40.4 


38.9 


104.8 

104.9 

104.5 


102.0 


9 


40.5 


38.6 

38,6 


101.5 

101.5 


10 


40.3 


11 


40.1 


38.2 


104.2 


100.8 


12 


40.1 


38.1 


104.2 


100.6 


13 


39.9 


37.9 


103.8 


100. 











ally. 



Plate II. illustrates the same fact grapic- 



PLi^TE n 











7 


d 


9 






72 


73 




^0 




^ ' 




















3f 






- -« — 


















38 












^ -if-- 












37 










ick 










- -a 




36 








i 













































— 74 — 



Vogl says on the effect of the baths on the f ever- 
cnrve the following : "The highest temperature 
is furnished by the evening of the day on which 
the patient is admitted to the hospital or perhaps 
on the day following ; during the next days al- 
ready it will be lowered and with it the average 
temperature — provided that the baths do their 
duty, and that is the rule. It is a matter of in- 
difference whether we have had on the first day 
a continuous fever with a rapid ascent after each 
bath, or if from the stai't the resistance against 
the baths was less vigorous on the second or third 
day by the continuous interruption of the ascent, 
this tendency is overcome, and thus the average 
temperature is lowered beneath that of the first 
clay. Thus a reduction of some tenths of a de- 
gree from day to day is brought about through 
the whole period of the acme, whether this should 
last one, two or three weeks. 

This course may be looked upon as typical 
of the water treatment, it is reached the more 
certainly and completely if the baths have the 
the chance to exert their influence from the very 
first day of the akme, but it can also be brought 
about, although not in such a pure form, after 
several days of the acme liave passed by. Even 
if it is not ])ossible to pr(Mluce a reduction of the 
average temperature, a further rising of the same 
is prevented. 



— 75 — 



If the acme is of two weeks duration the 
average temperature of the first week will be 39° 
and over, with evening exacerbations of 40° and 
over, of the second week 38° and over with 
exacerbations of 39° and over, to decline in the 
third week. 

It can thus be said that the cold baths will 
(w^ithout masking the day- and night-periods, and 
without interfering with the appearance of the 
normal maxima) force down the exacerbations by 
numerous small remissions, and by their unre- 
mitting action gradually and certainly force the 
average values to a lower level. This is the rule 
which has the fewer exceptions the earlier the 
case comes under treatment." 

It may be worth while to remind the reader, 
while he is comparing the figures from Wunder- 
lich's and Vogl's case, that whereas in the cases 
treated with medicines or expectatively, the figures 
given show the temperatures to whicli the patient 
was actually exposed, the figures from the case 
treated hydriatically have not the same signifi- 
cance, here 8 — 12 remissions occurred, not ap- 
pearing in the curve lasting each 1 — 2 hours, 
during which the patient was at a low, almost 
n orm al t e m perat u re . 

Vogl points out the important clinical fact 
that the water treatment does permit an insight 



— 76 — 



into the nature of the case, whether it be one of 
grave or mild character. 

The favorable results of the water treatment 
have been met by the objection that all these 
cases were of a milcl form, and would have re- 
covered anyhow. The resistance which the fever 
offei's to its reduction Avill demonstrate the grav- 
ity or mildness of the case, and thus allow to 
judge of the value of the treatment. 

The results obtained by T. and B. on the 
effect of the baths on the fever-curve agree very 
well with those obtained by Yogi. Their con- 
clusions are based on 84 curves obtained in the 
following way. The temperature was taken 
before each bath, generally eight times a day; 
of these the average was taken, indicating the 
status of the fever for that day. Plate III. is an 
illustration of such a curve. The upper giving 
two of the eight absolute measurements, the lower 
the average temperature for the day. It must, 
however, not be forgotten, that the patient was 
actually at a lower temperature two-thirds of the 
time, the notation not indicating the remissions 
brought about by the bath. 

*'The examination of these 84 curves." T. 
and B. say, ^4eads to the folio win propositions : 

(1) The average temperatiive of the first day 
is a maximum which all the future daily averages 
'will not exceed, no matter in which period of the 



— 77 — 



disease the treatment may have begun, or in other 
words : this average of the first day is the highest 
jjoijit of the averages of the maximum tempera- 
ture. 

A rare exception to this rule may occur if a 
grave case comes under treatment very early, 
while the temperature is yet rising from day to 
day ; here the upward tendency of the fever 
cannot be suppressed. — Cases of agrave character, 
however, are not rare in which treatment was 
begun on the fourth day, hence befo re the acme 
had been reached, where the average of the 
maxima of that way w^ere the highest of the 
curve . 

(2) From this maximum of the first day the 
curve descends to a point near the temperature of 
3.9.0°, and then bends down slower or faster, ac- 
cording to the nature of the case to stop at the nor- 
mal temjjerature of 37.5°. These remarkable re- 
sults are obtained by the cold bath treatment 
only, and no other medication can bring them 
about. 

These two propositions will hold good for 
the great majority of cases, but only if the treat- 
ment is carried out strictly after Brand.'' 

T. & B. following Brand divide tlie disease 
under hydriatic treatment into tliree periods : 
The period of the combat with the fever, the 



period of relative pyrexia, and the period of de- 
fervescence. 

They divide the cases into three groups : 
In the mild cases there is no combat with the fe- 
ver. After a day's treatment the fever begins 
to abate, and is lowered from day to day, so that 
in the mild forms we can speak only of a period 
of defervescence, which begins with the first day 
of treatment. Kor is the period of the disease, 
in which the patients come under treatment, of 
any consequence, the fall of the temperature be- 
ginning at once whether the patient is bathed on 
on the fourth or fourteenth day. It seems that 
in the mild forms the pathological process offers 
but little resistance to the cooling process, and 
a moderate refrigeration of short duration will 
produce a permanent lowering of the tempera- 
ture. The steep curves which are found in 
cases treated expectatively or with medicine, 
during the last stage of the disease, due to high 
evening temperatures associated with low or nor- 
mal morning temperatures, disappear altogether, 
the baths successfully interfering with the rise in 
the latter part of the day. 

T. and B. are inclined to the view, that the 
water treatment does actually shorten cases of 
this mild form, becauso the action of the water is 
always of the same prompt effect, in all stages of 
the disease. 



— 79 — 



*^In cases of medium gravity the fever re- 
sists the process of cooling far more. This can be 
seen at once from the curve of the averages of 
the maxima. Defervescence exists as in miki 
cases, but this is preceded by a shorter or longer 
period, depending on the nature of the case, in 
which the daily averages remain on the same 
level or undergo at least but moderate vacilla- 
tions about that point. While graphically the 
curve of the mild forms consists of a series of 
steps (defervescence), this form has the steps 
preceded by a platform. 

This can be seen on Plate TII. where the 
curve of a case of medium gravity is presented, 
treated from the fourth day. Undoubtedly the 
period of ascent had not come to a close when 
the first bath was given. Yet the curve descends 
from the second day of treatment and only after 
the fourth day of combat the first ^^step" of the 
period of defervescence can be seen." T. and B. 

Grave cases. The resistance against the cool- 
ing process is here still greater ; hence a new 
curve. Between the period of combat and the 
period of defervescence there is a new period pe- 
culiar to grave cases in which the daily averages 
of the maxima remain almost at the same level, 
in the neighborhood of 39°. This period is the 
period of relative apyrexia of Brand. Inasmuch 
as the curve of the averages of the maxima re- 



PLATE m 




— 81 — 



mains in the neighborhood of 39°, the fever of 
course continues, but the fever moderated by the 
cold water ceases to be dangerous. The eight 
daily remissions lasting 1 — 2 hours must not be 
forgotten, inspecting such a curve as is seen on 
Plate III. Hence when after a more or less 
prolonged combat with the fever the curve ap- 
proaches 39°, and wdth this period of relative apy- 
rexia an improvement in the general condition be 
and an amelioration of the grave symptoms can 
be observed. 

The following table shows the duration of 
the different periods in 18 grave cases. 



Beginning 
of 

Treatment. 


Duration of 

Combat 
with fever. 


Duration of 
relative 
apyrexia. 


Duration of 
Defer- 
vescence. 


Total 
Duration. 


4th day 

4 


4 


21 days 

7 


6 davs 

8 \ 


34 days... 
22 


5 


5 


19 


6 


32 




8 


6 


6 


26 


7 


2 




6 


28 


7 


6 


1 :::::: 


9 


26 


8 


7 






37 


9 


7 


1 


10 


31 


9 


3 





6 


39 


9 


7 


9 


7 


32 


10 


3 


13 


7 


32 


11 




7 


3 


25 


13 


5 


8 


? 


9 


14 


8 7 


6 


31 






15 


7 


40 


17 


1 


18 


7 


42 


16 


7 


9 


7 


38 


'22 


8 


5 


7 


40 













— 82 — 



The number of baths necessary to effect ifally 
combat such cases is at times considerable; 80, 
90, 100—120 baths have thus not rarely been 
used." T. and B. 

Comparing the results of Vogl with those of 
Tripier and Bouveret, we see that in the es- 
sential points they agree, which is that the baths 
will not only cool off the patient for the time 
being, but that they further have the power to 
change the typical curve of the fever by prevent- 
ing, after a shorter or a longer time, the tempera- 
ture from rising to its former height and enabling 
the organism, more and more from day to day, to 
bring its temperature down to the normal condi- 
tion, the patient thus passing through the phases 
of the disease at a lower temperature due partly 
to the repeated cooling of the body, partly by 
enabling the heat-regulating apparatus of the 
body to carry on its function nearer to the nor- 
mal way, and thus preventing the production or 
accumulation of abnormal heat-quantities. 

Compare also the table at the end of the 
volume, presenting the curves of two cases by 
Brand . 

The Influence of the Cool Baths on the 
CiRCULATOPvY Organs. 
Yogi has found the following results: ''The 
increase of the pulse-rate, which generally is 100, 
when the patient is admitted, is cut down, and 



— 83 — 



that even more promptly than the temperature. 
As in the single bath, the pulse is influenced be- 
fore the temperature, so the constant reaction 
of the baths during the first days of the fever 
shows itself more promptly and more energetic- 
ally in the innervation of the heart than in the 
regulation of the heat-regulating-organs. The 
evening pulse goes down generally, even on the 
second day to 96 — 92, even to 84 and remains at 
this level throughout the acme, even if the 
evening temperature of the first week remains 
between 40 and 41°, and that of the second week 
between 39 and 40°. This condition can be ob- 
served in so many of our cases, that it may be 
looked upon as the rule — exceptions however are 
not excluded. It was rarer for the pulse to ex- 
ceed 108 during the entire acme of the fever, 
than to remain normal — excluding the day of 
admission — even if accompanied by relatively 
high temperatures. This decrease of the pulse 
rate was constant in the cases with an acme of 
one week's duration, even if high temperatures 
were present, and of almost regular occurence in 
the cases, where the acme lasts 2 — 3 weeks. 

An insufficient influence of the baths on the 
frequency of the pulse indicating a more or less 
dangerous condition of the patient, the pulse rate 
has, through the baths, gained in importance as 
a prognostic sign; at the same time it furnishes ^ 



— 84 — 



most urgent indication for increasing the amount 
of stimulants in a liberal way — as much as the 
patient will bear — but not to cliscoutinue the use 
of the baths. Acting according to this principle 
one has at times the satisfaction to see results 
which seem to contraindicate the rules of prog- 
nosis based on the pulse. In two of our cases, 
which had come under treatment too late, the 
pulse remained between 128 and 132 for a num- 
ber of days, and in one case the pulse varied be- 
tween 120 and 148 for three weeks with evening 
exacerbations of 40° but considerable morning- 
remissions. All three cases recovered. In these 
very cases, which so frequently are looked upon 
ascontraindicating the use of the baths, it becomes 
apparent how the heart is induced by the cold 
baths to do fresh work, and enabled to perform 
it, not, however, without liberal allowances of al- 
cohol. 

That the marked and permanent decrease 
in the frequency of the pulse is after a number 
of baths accompanied by a favorable change in 
the quality of the pulse, is what might be ex- 
pected. It may be asserted, that the dicrotism 
of the pulse under the methodical administration 
of the baths has become as rare as it was frequent 
formerly. It was observed in the neglected 
cases mentioued above either at their admission 
01' later on. when the heart began to grow 



85 



Weaker. It is not rare, that when well marked 
at the time of admission, the acme having prob- 
ably been in progress for 3—4 days, the dicro- 
tism is again suppressed even if the frequency 
of the pulse is not decreased, the latter in 
general apparently not corresponding with the 
dicrotism. 

Kobody disputes or refutes these statements 
concerning the stimulating properties of the cold 
^vater on the innervation of the heart, but in 
practice there is the inclination to fear the op- 
posite. The theoretical fear of collapse as an ef- 
fect of cold on an intact, and even more on an al- 
ready insufficient heart-action, is too often an 
impediment for the first trial or the continuation 
of the cold-bath-treatment. And yet in the first 
days the weakness of the heart which, as indica- 
ted by a weak apex-impulse, feeble heart-sounds 
and arythmic beat, while of rare occurrence, is 
the most urging indication for the administration 
of the cold baths, and the most certain and re- 
liable measure against anything like collapse. 

The condition however, of the patient in and 
after the bath which so frequently is the occasion 
for the discontinuance of the procedure is not 
collapse at all. In this matter experience must 
be allowed to have a voice: we have in the course 
of 15 years during which thousands of baths have 
been given not only in enteric fever, but also 



^ m ^ 



in pneumonia, gcarlet fever etc., not oi3served in 
a single instance a condition which could be 
called collapse either in connection with high or 
low temperatures. It may be admitted, that a 
prolonged coolness of the body surface, accom- 
panied by chilliness, goose-skin, shattering of 
teeth and a blueish color of the face, together 
with a scarcely palpable, contracted pulse are 
undesirable phenomena for the physician as well 
as for the patient. They signify that something- 
has been omitted in the procedure tending to 
keep up the peripheral circulation : energetic 
friction, rapid w^arming and the administration 
of stimulants. A more minute attention to these 
points will prevent the recurrence of this condi- 
tion. 

Ziemssen expresses himself in the same way 
when arguing that not a slight chill, but a de- 
cided shivering, a rigor is to be the sign deter- 
mining the end of the bath, that one is inclined 
to be too timid with reference to the complaints 
of the patient and the objective signs of the vig- 
orous contraction of the blood-vessels of the 
skin; that in the course of time one grows more 
callous in the matter and does not pay so much 
attention to the pulse which after the bath is apt 
to be small and difficult to feel. 

Experience then, favors that view, w^hich 
does not see in a frequent pulse, especially in the 



^ 87 — 



first days of the acme, a contraindication for 
the bath, hut on the other hand, rather an indi- 
cation, excluding of course conditions which will 
not escape the watchful eye of the physician. 
The closer these principles are adhered to, the 
more conspicuous will be the favorable influence 
of the baths on the heart and at the same time 
their harmlessness will become apparent." 

Tripier and Bouveret have the following to 
say on the effect of the baths on the circulatory 
organs: ^'The cold water, the cool bath, is a true 
tonic for the heart* The cold bath prevents the 
acceleration of the pulse and makes it stronger, 
it diminishes or removes the first sign of heart- 
w^eakness. This takes place however, thoroughly 
only if the treatment is begun early and carried 
out methodically. If begun at a later date this 
relation is less favorable, and threatening heart- 
failure in a very advanced stage of the disease 
will require a modification of the ordinary 
formula. 

Some minutes after the patient is placed in 
the cool bath the pulse increases in number, the 
artery is more tense and with difiiculty to be felt 
at the wrist. This initial accelaration is more 
frequent Avith women than with men, and par- 
ticularly pronounced in nervous women. To- 
Avards the end of the bath the frequency of the 
pulse is diminished, it may be less than before 



the bath. When the patient, shivering fronl 
cold, is brought back to bed, the diminution of 
the 23ulse is still more marked, and 10 — 30 min- 
utes later 4, 6, 10 beats less are counted than be- 
fore the bath. This minimum almost coincides 
with the greatest reduction of the temperature ; 
but the higher the temperature rises after the 
bath, and the more that the beneficial effects of 
the bath pass away, the more doe? the pulse in- 
crease, and at the same time the redness of the 
face, the dryness of the mouth, the head- 
ache, and, in short, all the symj^toms return 
which furnish the conditions for the repetition 
of the bath. — The influence of the cold bath on the 
pulse is, as might be expected, different under 
different circumstances. In the cases of a grave 
character from the beginning, accompanied by 
severe nervous symptoms and rapid pulse, the 
first baths often produce but a very moderate 
diminution of the frequency of the pulse. After. 
3 — 5 days of the treatment the influence of the 
baths is greater, and one-half, one hour and more 
after each bath, the pulse is diminished 8 — 10 
beats. In mild cases and those of medium 
gravity this favorable result is obtained earlier, 
often after the first baths. Generally the pulse 
rate remains low in a case of enteric fever 
treated systematically and from the beginning. 
Even in grave cases not over 110 — 120 beats 



— 8§ 

are counted. One cannot see here, as in cases 
treated with medicines, that the pulse rises higher 
and higher up to 130, 140, and 150 beats, indicating 
by its frequency a weak condition of the heart. 
The pulse curve does not rise in the course of the 
fever, it remains stationary or sinks, keeping 
parallel to the temperature curve. 

A dicrotic pulse is always a sign of a certain 
weakness of the heart and the blood-vessels. Ac- 
cording to Brand dicrotism can be absent even 
in /grave cases during the whole course of the 
sickness, as long as the treatment is begun early 
and carried out according to the rule. If di- 
dicrotism is present in the beginning of the 
disease, it disappears sooner or later under the 
new regime. The influence of the bath on the 
pulse, increasing its frequency and suppressing 
the dicrotism, is certain proof of the tonic effect 
of the bath not only on the heart but also on 
the peripheral blood-vessels. The high and con- 
tinuous fever produces the paralytic relaxation 
of the muscular coat of the arteries, which ac- 
cording to Marey is the cause of dicrotism, which 
we see too frequently in typhoid fever. The ef- 
fect of the cold bath on the nerves of the skin 
raises the tonus and produces even a vigorous 
contraction of the arteries, hence the complete 
disappearance of the dicrotism. 

But, as on the temperature, so on the pulse 



- 90 



the influence of the bath is transient only, so that 
the pulse c^ooli becomes moi'e frequent and dicro- 
tic again i The following seven sphygrnographic 
curves show the gradual modification of the pulse 
between two baths. (See Plate IV.) The ob- 
servations were made on a young man, a case 
of medium gravity, bathed from the tenth day 
on* 

Before the bath the pulse is large, its dicro- 
tism very marked, pointing by this peculiarty to 
a diminished tonus of the arteries. A half an 
hour afterwards the pulse is slower, not so high, 
and shows no trace of dicrotism; the tonus of the 
arterial wall has returned, the artery itself is so 
contracted, that it is difficult to obtain the 
tracings of the pulse curve. One hour after the 
bath the pulse has regained a certain volume, 
and the dicrotism begins to reappear. After this 
the tonic effect of the bath grows weaker 
and weaker, so that after three hours the pulse 
has regained its former peculiarity excepting as 
to the volume, which remains somewhat reduced. 
Placing these sphygrnographic curves side by side 
one can see plainly the relaxation of the muscular 
coat of the artery. — Every bath produces the 
same modification : a prompt stimulation followed 
by diminution of the arterial tonus. But the 
oftener the baths are repeated, the more perma- 
nent will this increase of the arterial tonus be- 



— 91 — 
PLATE nZ. 





2 'Howi ^fter 'M^e i^di-A. 



— 92 — 



come, so that the dicrotism will only appear in 
the last part of the interval between the baths 
and at last will disappear altogether. • 

It may thus justly be said, that the Brand 
method increases the energy of the heart and the 
tonus of the vessels and prevents heart failure. 
Hence also the favorable influence it exerts on 
the initial congestions and hemorrhages. Not 
rarely epistaxis, metro rhagia, haemoptysis and 
certain initial intestinal hemorrhages are lessened 
and finally disappear, after the administration 
of a few baths. Gianini knew this in the be- 
ginning of our century and concluded therefore 
that the pold bath was a true remedy for grave 
hemorrhages in the first stage of febrile diseases. 
The later congestions are not influenced as 
favorably." 

The Influence of the Cold Baths on the 
Respiratoky Organs. 

On this point Vogl says: ' ^If the patients are 
admitted with the symptons of bronchitis, these 
remain of moderate intensity; extreme conges- 
tion of the bronchial mucous membrane, and ex- 
cessive secretions from it do not occur. The pa- 
tients rarely require a spittoon, only during their 
stay in the bath thoy cough up some catarrhal 
sputum by energetic hawking. There is no ac- 
celeration of the respiration and the blueish-red 



— 93 — 



complexion is absent ; hence hypostatic, atelec- 
tatic, pneumonic complications have become a 
rare occurence." 

Discussing the influence of the baths on 
bronchial and pneumonic complication Tripier 
and Bouveret say the following: ^ 'Cases treated 
from the beginning exert a beneficial influence 
on these complications. The sudden action of 
the cold bath on the skin stimulates the centres 
of respiration and excite coughing; furthermore 
an uncreased activity of the circulation of the 
blood in the lungs, and an easy expectorotion of 
the bronchial secretion. By lowering the tem- 
perature, and making the system almost fever- 
less the cold water prevents weakness of the heart 
and its dangerous consequences on the pulmonic 
circulation. The early use of the water treat- 
ment therefore acts principally as a prophylactic 
measure." 

The Influence of the Cool Baths on the 
Digestive Organs. 

"Rapid improvement of the disturbances 
of digestion is a constant and remarkable effect of 
the Brand method. In cases treated from the 
beginning this improvement is a sort of criterion 
whether the method is applied well, as it ought 
to be or the contrary. From the first days of 
treatment on, the fuliginous coating must have 



— 94 — 



disajDpeared and the tongue have become moist 
and red. If this does not occur in a case treated 
early, one ought to look around for possible ir- 
regularities and defects in the treatment. 

The mouth of typhoid fever patients soon 
takes on almost a normal appearance. The se- 
cretion of the salivary glands returns and re- 
mains sufficient to keep the mouth moist. The 
patients are well pleased with the benefit they 
thus receive. The dryness of the pharynx is a 
very unpleasant symptom; it depends on an hy- 
peraemic condition of the mucus membrane often 
covered with dried mucus. Under the influence 
of the baths mouth and pharynx are kept clean, 
and the annoying sensations disappear. 

Taste and appetite soon return. Patients 
treated at the proper time partake with jDleasure 
of the nourishment which is permitted them. 
The general treatment, the repetition of the 
baths as often as demanded by the intensity and 
the continuation of the fever, is generally suf- 
ficient to produce this favorable result. To 
bring about however, a rapid improvement, at- 
tention must be paid to patients frequently 
taking fluids, and to his washing his mouth with 
cold water with each bath. There are exceptions. 
In two of our 233 cases the dryness of the mouth 
and tongue persisted throughout the sickness; 
both bad been bathed, one since the 9th and the 



— 95 — 



other since the 10th day of sickness, in both 
cases the fever and diarrhoea were marked, both 
recovered. 

The initial catarrh of the stomach generally 
disappears after the first baths. In case the 
patient had been vomiting, he will after a few 
baths cease to do so. The changes in the circu- 
lation and secretion of the mucous membrane 
which take place under our eyes, permit the as- 
sumption, that at the same time a similar change 
in the secretion and circulation of the mucous 
membrane of the stomach is going on. We have, 
furthermore, a proof for this in the early return 
of the appetite. The combat with the fever 
generall lasts three to four days. In this period 
the patient does not refuse to take broth and 
soups and desires nothing further. When the 
period of relative apyrexia sets in, when the 
thermometric curve desends, when the remission 
after each bath is deeper and of longer duration, 
the full appetite returns and soon the deepest 
concern of the patient is to know when he shall 
be allowed solid food. After each bath, milk 
soup without bread broth etc. is given ; this 
fluid nourishment is well borne and digested. 
Thirst, in the beginning acute, is now moderate. 
Is this not a proof for the disappearance of the 
catarrhal condition of the stomach and the re-: 
turn of the normal secretioiis ? 



— 96 — 



The diarrhoea generally diminished in the 
beginning is definitely suppressed in the course 
of five to six days. This fortunate modification 
of the intestinal catarrh is almost constant at 
least in cases treated from the beginning. — A 
typhoid fever patient, near the eighth day of 
sickness, has ileo-coecal gurgling, meteorism and 
eight to ten liquid passages per day, on the sec- 
ond or third day of treatment he has not more 
than four to five, on the fourth or fifth day 
day only two to three passages ; and after a 
week or somewhat later the diarrhoea has ceased; 
the passages being of normal consistency; at times 
constipation even sets in. To procure this result 
it is necessary to cover the abdomen with cold com- 
presses between the bath, besides carrying out the 
general hydriatic treatment. — Twice we have seen 
the diarrhoea to continue for a longtime, without 
being influenced in any way by the treatment. 
These two patients had been subjected to the 
cool-bath-treatment one from the seventh, the 
other from the eighth day of the sickness; hence 
not late in the disease. 

The meteorism is subjected to almost the 
same changes as the diarrhoea ; it is diminished 
and disappears altogether after five to eight 
days. This is the rule. The abdominal wall 
becomes even and soft. This could be observed 
in cases of grave character and such as had been 



— 97 — 



bathed in a late stage. The cold baths augment 
the tonus of the intestines and favor the expul- 
sion of the gases, not only in typhoid fever, but 
also in other fever cases. 

At times the baths produce abdominal pains 
which are difficult to explain, but Avhich need 
not interfere with the continuation of the bath- 
ing. 

Is it possible for the Brand method to have 
a favorable influence on the affection of the in- 
testines peculiar to typhoid fever? Can it pre- 
vent or moderate the ulceration of Peyer's 
patches ? This is a question much disputed and 
discussed. Brand is of the opinion that the 
method is able to accomplish this, but his opin- 
ion is combated energetically even in Germany 
by the majority of the pathologists; only Hagen- 
bach (Vogl also) believes in a favorable in- 
fluence of the baths on the local processes in the 
intestines. 

The arguments which Brand adduces are 
worthy of consideration. In the flrst place it is 
indispensable that the cold baths be administered 
quite from the beginning of the disease. It is 
obvious that the result mentioned can never be 
expected if the treatment is begun in an advanced 
stage of the disease, when the inflltration of the 
plaques has attained a high degree and the stage 
of ulceration is near at hand. Brand lays stress 

7 



— 98 — 



OD the point, that he has only cases in mind that 
have been under treatment from the start when 
he writes: *'! say. if the patient can l3e treated 
and is treated from the promonitory stage to the 
third day inclusive, ulcerations of the intestines 
do not occur. For this view I have the following 
reasons : 

1) A patient treated with water from the 
beginning presents none of the symptoms, which 
would in any way point to ulceration of the 
bowels. The mucous membrane of the mouth is 
moist, the tongue pale and clean, thirst is ab- 
sent, the appetite stronger than desirable. Xo 
meteorism, no gurgling, no pain in the ileo- 
coecal region. The passages are normal — in 
short there is wanting every sign of an affection 
of the intestinal tract. 

2) There never occur in such cases the se- 
quelae of the intestinal affection : degeneration, 
hemorrhage, perforation. In case ulceration had 
taken place these could not possibly remain in 
abeyance, nor could the mortality be reduced to 
such a degree, as it actually is, inasmuch as the 
hydriatic treatment has no influence on the fully 
formed ulcer. 

3) The statistics of the intestinal hemorr- 
hage sli«)w, that all these cases had come under 
treatment in a later period, — too late. Besides 
everybody (even those who are not friendly to 



— 99 — 



the method), affirms, that the earlier the case 
comes under treatment, the more certain the ef- 
fect will be. 

4) I imagine this is what takes place: Pa- 
thological anatomy teaches that the formation of 
ulcers is not necessary in a case of typhoid fever. 
In the milder cases, especially those not accom- 
panied by high temperatures, the affection of the 
glands proceeds only as far as the stage of in- 
filtration and then goes back, without having 
proceeded to the stage of ulceration. 

To this class of cases the typhoid fever 
treated from the beginning belongs. It takes as 
mild a course as the mild typhoid fever, and its 
temperature is even below that of the latter form. 
What nature does in the one case, art does in the 
other." (T. & B.) 

Vogl says the following on the influence of 
the cool baths on the intestinal tract: ^'The di- 
minution of the intestinal symptoms is one of the 
most obvious effects of the cold bath ; a short 
series of experiments with the strict method ex- 
cluding all medication, will cause surprise by its 
favorable results. We have seen diarrhoea in a 
degree worth mentioning, only in cases at their 
admission, after two to three days of systematic 
treatment, it either ceased altogether or contin- 
ued for a short time in the form of one to two 
evacuations daily. If diarrhoea has actually set 



— 100 — 



ill while the cases ^ye^e under treatment, it has 
lasted but a few days, with one to two evacua- 
tions. 

Very many cases did not even have diar- 
rhoea during the w^hole course of the sickness, 
but a formed stool every two to three days. 
More than four diarrhoeic movements are not 
noted down amongst the whole of our material, 
not even in the fatal cases. 

In the histories of our cases we have classi- 
fied the dejections into soft, liquid, and formed, 
and applied to the two former the term diarrhoea ; 
thus we had for our 221 cases, treated strictly, 
0.7 diarrhoeic evacuation per day, and amongst 
these the typical typhoid fever stools Avere the less 
frequent. 

Meteor ism, with tense abdominal walls only 
such cases presented, which had been rather well 
advanced in the acme ; after the first baths this 
receded, and did not develop further under the 
Avater treatment, than to be recognized by per- 
cussion in the examination of the spleen. 

As is known. Brand has ascribed to the early 
and systematic administration of his method the 
powder to interfere with the development of the 
intestinal ulcers, i. e. to confine the pathological 
changes in the glands to the stage of infiltration. 
The anatomical proof for this view, Avhich I 



— 101 — 



also accept, is for obvious reasons difficult to 
obtain, and so is the counter proof. 

Watching the course of the disease in cases 
subjected to hydriatic treatment from beginning 
to end, one can perceive at once, that from the 
symptoms pertaining to the digestive tract one 
cannot form any conclusions as to any anatomi- 
cal changes, which were used in former times in 
dividing the disease into periods : in the first 
week infiltration of the follicles and plaques — 
accompanied by moderate diarrhoea or often con- 
stipation, in the second and third week formation 
of sloughs in the affected glands — accompanied 
by more or less violent diarrhoea, meteorism, 
hemorrhage, and other complications, with entire 
loss of appetite and the characteristic fuliginous 
condition of the tongue etc., in the third and 
fourth week, the stage of defervescence — separa- 
tion of sloughs accompanied by the sudden dis- 
appearance of intestinal symptoms, sudden re- 
turn of appetite, while the previous diarrhoea 
and meteorism had existed, at times grave hem- 
orrhages from a torn vessel at the period of the 
separation of the sloughs, finally cicatrization 
in the stage of reconvalescense, accompanied by 
voracious appetite and constipation. The course 
of the disease under the cool-bath -treatment does 
not indicate any connection between the clinical 
features of the fever and the symptoms due to 



— 102 — 



the local condition of the bowels, the former is 
modified, but its type is retained ; the latter are 
almost wholly suppressed, and, if present, con- 
fined to a period of a few days. It may be said, 
that the cold baths have led the local processes 
into better paths, just as harmful factors have 
the power to give them a bad turn." 

To explain the mildness of the intestinal 
symptoms, Vogl^ in the first place rejects the 
suggestion, that his cases may have been mild or 
abortive ones. Of this class, those, which are 
characterized by a short duration do not form 
the basis for his conclusions, and are not ad- 
mitted into the statistics. That his cases were 
of a grave character, can be seen by the number 
of baths they required, the length of the fever- 
acme and the height of the fever at their admis- 
sion. For a clinical analogy, VogI points to the 
abortive and mild forms of the disease, where, with 
Liebenneister it may be reasonable to assume, 
that in the former cases, the infiltration, though 
intense is of such short duration, that no slough- 
ing takes place, and that in the latter (the mild 
forms) no ulceration takes place, because the 
infiltration is not of severe enough a character 
to reach this stage. 

"To acomplish through medical art, what 
in such cases is brouglit about by a mild infec- 
tion or a peculiar resisting power of the iudi- 



— 108 — 



vicinal, is the programme and the actual result of 
the strict methodical treatment with cool baths ; 
and if one is inclined to accept the view of 
Liebermeister of the rarity of the sloughing in 
the mild forms even of four weeks duration one 
cannot reject the view, that in the cases which 
on account of remedial influences have a similar 
mild course and the same duration, ulceration 
occurs just as rarely and in the same small de- 
gree — always assuming the early administration 
of the baths. This is a part of their general 
prophylactic influence." (Vogl.) 

VogVs view then is : The cool baths have 
not only an antipyretic effect, by their influence 
on the circulation they furnish the necessary 
condition for the affected organs, such as the 
glandular structures of the bowels to protect 
themselves, so that the pathological process Avill 
stay within certain dangerless limits; this modi- 
fied process on the other hand will not produce 
such deterious changes in the system in general, 
and so the bathing process makes out of a severe 
case a mild case. To explain the clinical phe- 
nomena Vogl offers the following suggestions : 
^SJust as in other organs and tissues an improve- 
ment in the blood current — i. e. an equalization 
of its distribution — is brought about by the tonic 
action of the cold baths, this condition is also 
brought about in the circulation of the mucous 



— 104 — 



membrane of the inter^tines ; from such an effect 
the territory infected by the baccilli, the glands 
and plaques, cannot be excluded, their tissues 
which are endangered by disturbances in the cir- 
culation and approaching the stage of necrosis 
can be influenced only in a favorable way by 
the changes in the blood-pressure-relations, which 
the persistent application of the cold baths to the 
surface of the body are able to bring about. The 
dangerous effects of the mikro-organisms. Avhich 
are deposited in large number in the deeper 
layers of the plaques and the mesenteric glands 
can be thoroughly counteracted until these are 
eliminated in the typical course of the disease. 
A shortening of the course of the disease through 
the annihilation of the pathogenic organisms dur- 
ing their development in the glandular organs by 
some thermic effect or a specific abortive action 
can not be ascribed to the cold bath treatment; 
this methodonly keeps up the vital processes in the 
diseased and endangered tissues, which is of 
course the more readily possible the less the 
physiological conditions in the diseased parts 
have Ijeen disturbed." 

The Ixfluexce of the Cool Baths on the 
Urinary Secretion. 

''If the method is applied early and very 
regularly, the urine, whatever form of typhoid 



— 105 — 



fever may be present, generally, after a few 
days of treatment increases in quantity. Even 
if the reduction of temperature is moderate and 
the fever resists the action of the cold, the 
amount of urine secreted in 24 hours is aug- 
mented very strikingly. If, however, the A^ic- 
torj is gained over the fever, the amount of 
urine, sooner or later, according to the more 
or less severe character of the disease (after 
the fifth to eighth day of treatment in cases of 
medium gravity), is increased still more for 
some days, so that the patient during the period 
of defervescense, presents considerable polyuria, 
which continues some days after the apyrexia 
has fully set in. Not rarely typhoid-fever- 
patients pass three, four or five litres (quarts, 
nearly) and ^ve have seen the polyuria increased 
for two to three days, towards the end of the 
defervesence to six to seven litres and more. 
Thus the amount of urine in case . . . . 
reached 4000 and 5000 cc, and once it ex- 
ceeded even 7000 cc. in 24 hours. 

The following table shows the course of the 
urinary secretion in a case treated regularly 
from the fourth day with cold haths according 
to our own observation. 



— 106 — 



Temperature. 



XT. 






be 












> 







.39,5 
.39,3 
.39,4 
.39,1 
.39,4 
.38,7 
.39,5 
.38,6 
.38,7 
.38,3 
.38,1 
.38,1 
.37,2 
.37,3 
.36,9 
.37,3 
.37,0 
.36,8 
.37,4 



.40. 
.39, 
.40, 
.39, 
.39, 
.40, 
.39, 
.39, 
.38, 
.38 
.38, 
.38, 
.38, 
.38 
.37 
.37, 
.37, 
.37, 
.37, 
.37 



A^mouut 
of urine 

in cubic 
centi- I 
meters. 



Bodv- 



weio-ht. 



1680 
2050 
3450 
2 700 
2900 
4500 
3500 
3400 
4000 
4300 
2700 
2200 



58 k 
50... 
58... 
58... 
58... 
57... 
56... 
56... 
56... 
56... 
55... 
55... 
54... 



54. 
55. 
55. 
56. 
57. 



700 gT 
000.... 
300.... 
500.... 
,100.... 
,200.... 
,600.... 
.600.... 
,100.... 
.000.... 
.700.... 
.100.... 
.400.... 
.500.... 
.300... 
.400.... 
.100.... 
.900.... 
.800.... 
.200.... 



Xumlier 
of 
Bath.^ 
i n 
24 hours. 



This was a case of medium gravity. The 
combat with the fever was carried out well, in 
the first two days the temperature of the baths 
had been reduced to 15 and 18^ (59 and 65° F. 
nearly). The patient received 60 Baths. The 
apyrexia setting in as early as the eighteenth 
day, Avas certainly brought about by the thor- 
oughness of the treatment. We consider it ex- 
ceedingly probable, that the fever wouhl have 



— i07 — 

lasted longer, if the case had been treated medi- 
cally or expectatively. We could present other 
tables, especially of grave and mild forms ; we 
have selected a case of medium gravity. The 
figures of Robin pertain to cases of such charac- 
ter. The comparison is very instructive. Robin 
has found the limits of the amount of urine se- 
creted in 24 hours to be 670 and 2010 cc, the 
average to be 900 — 1300 cc. Our figures are 
far higher ; the minimum is 1680, the maximum 
4500 and the average 3115 cc. All these figures 
are higher than the one, which expresses the 
average according to Robin, 1250 cc. The pa- 
tient therefore always had polyuria. The amount 
for the first three days is, we are sorry to say — 
not known, but on the eighth day, while the 
temperature was still 39.1 to 39.8 the amount of 
urine was already increased to 2050 cc, which 
is higher than the maximum quantity of Robin. 
Our maximum of 4500 cc. is reached on the 
twelfth day, when the temperature had been 
falling only two days. Finally the polyuria is 
still very marked when the apyrexia sets in on 
the eighteenth day. 

This urine secreted in such abundance is 
pale and resembles in many cases very much 
that of interstitial nephritis. It's specific gravity 
sinks to 1010, 1008, 1005 and even 1002. The 
minimum of Robin was 1008. This modification 



— 108 — 



of the specific gravity may set in rapidly even 
after a few days of treatment. 

Recent investigations in the pathology of 
the infectious diseases have thrown light on the 
role, which the function of the kidney plays in 
these diseases, and have shown that this is of no 
little importance. It may be said that the con- 
dition of the kidney has as much influence on 
the prognosis as the condition of the heart. By 
means of the kidneys the products of the febrile 
combustion are excreted, their retention in the 
blood of the fever-patient is the cause of the 
adynamia and the ty2:)hoid condition, which are 
found in the majority of the infectious diseases. 
The kidneys probably excrete the pathological 
micro -phytes and the dangerous products of their 
growth in the tissues and fluids of the body 
(Bouchard, LcjAne). To favor the excretion of 
these dangerous materials by the kidneys, or in 
other words, to keep up and augment the activ- 
ity of these glands, is one of the first tasks which 
the treatment of enteric fever has to fulfill. Far 
better than by any medication this is accom- 
plished by the method of Brand. From the first 
days of treatment on, the urine is increased in 
amount, and soon partakes of the character of the 
critical urine. Nor does the cool -bath -method 
require the introduction into the system of, and 
the saturation of the blood with more or less 



— 109 — 



dangerous drugs, the necessary excretion of 
which by the kidneys might endanger their in- 
tegrity." (T. & B.) 

Vogl's words on the action of the baths on 
the kidney are the following: ^'The condition of 
the kidneys in the cases treated methodically 
with cool baths shows itself by the increased 
function of this organ. Even in our first exper- 
iments in the quantity of the urinary secretion in 
comparison with former times was noticeable, and 
became more obvious the more perfectly and 
strictly the bathing was carried out. 

The measuring of the urine furnished by 
our fever-patients has been carried out systemat- 
ically for many years in the frame pavilions 
wdth reliable accuracy; the results have been re- 
corded daily. 

The first amount measured generally con- 
tains the patients urine for twelve hours, because 
ordinarily the patient is admitted by noon or 
somewhat later; the subsequent measurements re- 
fer to a period of 24 hours from eight o'clock in 
morning to the same hour next day» The volume 
gathered in the first 12 hours amounted to 700 
— 800 cc, of a dark, deep-yellow urine, turbid 
only at times from precipitated urates ; the 
smallest amount was 300 — 400 cc. (in twelve 
hours). 



— 110 — 



From the second day on, or one of the days 
following, throughout the whole acme and defer- 
vescence, we have observed in almost all cases 
polyuria, and selecting any year at haphazard, 
on the average 2900 cc, of clear and light col- 
ored urine, while the maximum and minimum 
was 4000 and 1200 cc. 

The increase in the quantity of urine is ob- 
viously to be ascribed to the cold baths, although 
the patient received at the same time larger 
amounts of fluid; a decrease occurred only, when 
diarrhoeic evacuations took place, which, as has 
been mentioned, has been a rare occurrence. 
The quantity of urine secreted during the period 
of the acme under the cold bath treatment, was 
greater than under symplomatic treatment in the 
period of defervescence and reconvalescence. 
Worthy of mentioning, and supporting the view^ 
proposed, Avas a case, Avho in spite of high tem- 
peratures throughout the acme, did not receive 
any baths, because the diagnosis, ^'enteric fever" 
on account of continuous pain in many joints, 
resembling rheumatism, with impure heart- 
sounds, could only be made in the period of de- 
fervescense on the strength of the steep curves ; 
the quantity of urine in this case amounted to 
1000 — 1300 cc. and never more. 

As far as the albuminuria is concerned, the 
urine of each patient was examined once in the 



— Ill 



niorDiug for albuinen; amongst the 221 cases it 
was present 14 times in form of a turbidity con- 
sisting of small flakes without any casts ; it de- 
creased on the next day or the days following, 
that is at a time when the polyuria was not as 
yet present in a marked degree, and disappeared 
when the same w^as fully developed. 

The influence of the baths on the renal cir- 
culation undoubtedly can be called a beneflcial 
one; this can be proven by the polyuria, the dis- 
appearance of the albuminuria, and the entire 
absence of nephritic processes in a later stage of 
the disease ; one may even ascribe to the cold 
baths a prophylactic effect against such kidney 
diseases as are apt to occur as complications of 
other aft'ections. This is shown by my experience 
in an epidemic of scarlet -fever occurring amongst 
the soldiers three years ago : on account of cir- 
cum'stances one part of the patients w^as treated 
expectatively the other part— the cases all being 
of the same type and the same gravity — through- 
out the acme with cold baths (a bath of 16 — 18° 
R. (68 — 72.5° F.) every three hours at a* rectal 
temperature of 39° C. (102.2° F.) 

Of 69 patien ts subjected to the cold-bath - 
treatment, five had nephritis, of these there 
died 0. 

Of 56 patients not treated with water, nine 
had nephritis, of these there died 5. 



— 112 — 



The Influence of the Cool Baths on the 
Skin. 

It is known how frequent and unpleasant a 
eojnplication decubitus in grave cases treated 
medicinally is, accompanied by undermining ab- 
scesses, wliicli often endanger life and letard re- 
convalescence. It is one of the greatest merits of the 
Brand method, to cause this unpleasant symp- 
tom to disappear or at least to make it a good 
deal less frequent. In our hospitals at Lyon the 
decubitus of the sacral region is an exception; to 
a greater degree is this the case in private prac- 
tice where the treatment has been carried out 
from the very beginning. 

The baths reduce the frequency and the 
abundance of the perspiration : sweating in the 
course of the water-treatment is a rare exception 
and even in the stage of the crisis is more fre- 
quently missed than observed. (Brand.) Since 
we have treated our cases with cold baths, we 
have not observed a sudoral form of typhoid fe- 
ver. A typhoid-fever case bathed regularly: 
The skin is soft and slightly moist; its color is 
normal and only rarely it is covered by a moder- 
ately abundant perspiration. Hence sudamina 
are of rare occurence. If perspiration is never- 
thelesss produced, it generally occurs at the time 
of the disappearance of the fever, when the 
baths are not necessary any further. As we have 



— 113 — 



seen, even profuse perspirations are.no contrain- 
dication for this method, that is during high 
fever. 

Not rarely in the course of the treatment, 
generally, however, in the period of defervescence, 
a bright red discoloration makes its appearance 
on the extremities, nose, ears, hands and feet ac- 
companied by slight tumeef action of the skin 
glistening and smooth in character. This red- 
dening is often accompanied by a sense of burn- 
ing, pain in the joints and oedema of the ex- 
tremities. The red spots are pronounced after 
the bath during the the time of reaction but dis- 
appear after some hours. This vaso-motor dis- 
turbance is nothing of the nature of a complica- 
tion ; it is an unimportant accident devoid of 
danger." (T. & B.) 

The Influence of the Cool Baths on the 
Nervous System. 

^ ^Headache is constant even in mild ty- 
phoids, as a rule it disappears after the first baths. 
The patients are well aware of this, and on this 
account are not unwilling to have the treatment 
continued. In grave cases, the heacache lasts 
longer but is always moderated as soon as can be 
expected. Together with the headache, the 
irritability of the semes, hearing and sight is di- 
minished or ceases altogether. If the tinnitus 

8 



— 114 — 



lasts longer or sets iu in the stage of deferves- 
cence it is more apt to depend on a catarrh of the 
eustachian tube than on an irritiation of the nerve 
centres. The quieting effect of the bath is the 
cause of deep. In mild cases sleep returns after 
a few baths even, in grave cases after five, six or 
eight days, not only now and then, but the sleep 
is lasting and refreshing. The patients will com- 
plain bitterly about the severity of the treat- 
ment, which demands the bathing even at night. 
These complaints must of course not be heeded, 
because the fact that the bathing is carried out 
regularly even at night is the cause Avhich has 
enabled the patient to regain the capacity to 
sleep. A very few minutes after each bath the 
patient goes to sleep again, and it is not correct 
but injust to accuse ihe Brand method of dis- 
turbing the rest of the patients. This quieting 
of the disturbed functions of the nervous system 
modifies in a happy way the whole clinical 
picture and outward appearance of the typhoid 
fever. Few diseases furnish such a character- 
istic facies as enteric fever. It is often easy to 
pick out a typhoid fever case from amongst other 
cases. In our hospitals in Lyons such a diag- 
nosis is more difficult, and the most skilful ob- 
server is exposed to frequent errors. Directly 
after the bath the face is more or less* collapsed, 
lips and cheeks are slightly cyanotic, the whole 



~ 115 ~ 



body shivers from cold, his teeth shatter, and 
considerable time has to elapse before the patient 
regains the look and expression peculiar to ty- 
phoid fever, which generally is quiet and natural 
in the interval between the baths. Relieved from 
the insomnia and the head-ache the patient has a 
feeling of bien -etre which is unknown under any 
other method of treatment, and which is an in- 
ducement to a continuation of the same, inas- 
much as through its instrumentality the patient 
in cases not of the most severe type, passes 
through the disease in the illusion of perfect 
health . 

Early delirkim generally indicates a grave 
form of the disease. It is often accompanied by 
high temperatures and an accelerated pulse ; 
nevertheless at times typhoid fever patients are 
delirious in the first days, without their fever 
being high or the pulse very frequent. This 
form of disturbance of the central nervous sys- 
tem yields to the cooling process better than to 
any medication ; if — what seldom is the case — 
the delirium continues nevertheless, this is an 
unfavorable prognostic sign. In the type of en- 
teric fever, where delirium is one of the promi- 
nent symptoms, the cold water treatment has its 
most brilliant triumphs. 

Quite often after the first baths even, the 
delirium vanishes, The restlessness, however. 



— 116 — 



reappears in proportiou as the immediate effect 
of the bath passes away, i.e. when the tempera- 
ture rises anew. After two to three days of 
regular treatment, rarely later than that, the 
patient regains his full consciousness, knows his 
friends and answers questions correctly. — The 
effect is less prompt and complete when the 
disease has advanced to a later stage, and when 
the delirium has lasted several days before the 
treatment is instituted. 

The grave and delirious forms are accom- 
j)anied at times by symptoms of irritation in the 
motor sjyhere: rigidity of the muscles of the nape 
and back, contracture of the extremities and ec- 
lamptic convulsions. In nervous women there oc- 
cur not rarely during the first days hysterical con- 
vulsions. Similarly as in the case of the delirium 
these motor disturbances under the influence of 
the baths, are diminished and finally disaappear. 

Stupor and eoriio are graver symptoms than 
the jDreceding ones. Before the introduction of 
the Brand method all the enteric fever cases 
were doomed that were attended by coma from 
the beginning. In these grave cases the method 
if applied early and systematically, at times yields 
unexpected results. Generally, however, the 
removal of the coma can be brought about 
slowly only and with difficulty. One of our 
patients (bathed from the fifth day on) was 



^ lit ^ 



placed in the bath in the midst of his coma ; oil 
the next day already he came to, and remained 
clear in his mind. Two other cases with this 
complication (one bathed on the fourth, the 
other on the eighth day) died; in one of the 
cases the unconsciousness continued in spite of 
the cold water, in the other the coma disap- 
peared after the first baths, but progressive ady- 
namia led to a fatal issue. 

Improvement and even total disappearance 
of the gravest nervous symptoms do not always 
coincide with the reduction of the temperature. 
We often see delirium and ataxia disappear, 
when the fever remains |^high, and has not yet 
yielded to the cooling process. It is probable, 
therefore, that the cold water has a direct action 
on the nervous system, independent to a cer- 
tain degree of the abstraction of heat." (T. 
and B.) 

Vogl describes the influence of the cool 
baths on the nervous system thus: ^'The change 
in our typhoid-fever-patients is brought about 
from the first and second days on, and the stupor 
and depressson are replaced by fresh vitality of 
the nervous system after the baths of the first 
night : the patient answers promptly and correctly 
and expresses himself as satisfied, he can perform 
all actions and movements, eats without aid what 
is offered to him and sleeps quietly, though per- 



il8 ^ 



taps not a long time etCi In correspondence 
with the effect of the baths on the temperature, 
respiration^ pulse, the condition of the patient, 
which the evening before hardly admitted any 
doubt as to the diagnosis, seems to have become 
doubtful especially where tumefaction of the 
spleen, roseola, diarrhoea etc. have not aided in 
establishing the diagnosis. A single observation 
of this kind, and of the certainty with which 
such a change is brought about after four to six 
night baths is sufficient to enable any one to rec- 
ognize the relation of cause and effect and to 
convince him that a thorough continuation of 
this therapeutic measure must be successful in 
moderating the further course in a similar way 
and in confining it within certain limits. 

It can be affirmed and proven by experi- 
ment that a systematic and energetic administra- 
tion of this treatment can preserve the integrity 
of the functions of the central nervous system 
throughout an acme of one to four weeks, mild 
delirium is an exception, and the versatile and 
stupid forms of enteric fever are never de- 
veloped, so that this distinction for clinical pur- 
pose has no further value, nor can it be employed 
as an indication for warmer or colder baths. It 
hardly ever happens that a patient soils the bed 
or the bath, he asks for the chamber, the urinal, 
retention of urine which formerly so frequently 



i'e(|iurecl the use of the catheter is unknown, 
tlie patient sleeps in the intervals between the 
))aths and rests on his side, he takes plate and 
cnp in his hand, taking his meals, he is able — - 
though not permitted to do that — to go to bath, 
with staggering gait however, remains sitting in 
the bath rubbing himself continually with his 
hands etc. 

There never is an indication offered to conir 
bat states of irritations with narcotics. Since 15 
years it has not happened that a typhoid-fever- 
patient lias left his bed, or become violent 
against himself and others. We have not ob- 
served any nervous diseases or psychoses as se- 
quelae. 

But we must remark that the full vigor only 
of the treatment can achieve what has been pre- 
sented here and an interruption of the treatment 
either on account of some indication, or for the 
purpose of experiment, soon permits the caBe to 
assume those features which have been kept in 
abeyance by the administration of the baths. 

It is an open question, whether in typhoid- 
fever the disturbed function of the heart or of 
the nervous system, do furnish the greater dan- 
ger to life. But inasmuch as the anomalies of 
the nervous system in the ty])hoid stage give a 
good ])icture of the intensity of the infection and 
inasmuch as these anomalies can be kept down 



™ 120 



or i-eniovecl altogether through the stimulating 
effect on the nervous system brought about by 
the cold baths and kept up by the systematic 
continuation of the treatment, the chief function 
of any therapeutic measures consists in com- 
bating the nervous symptoms and the hydro- 
therapeutic method herein excels all others. The 
suppression of the status typhosus is the first link 
in the chain of favorable therapeutic results, 
necessarily followed by diminution of the com- 
plications and a lowering of the death-rate. No 
statistics on the mortality of enteric fever can be 
interpreted in favor of a therapeutic method, 
which alloivs the status typhosus to continue un- 
disturbed.^^ 

The independent testimony of these obser- 
vers will vouch for the correction of the descrip- 
tion of the general course of the disease which 
Brand gives in the following words : ^^The 
picture of the disease under the water treatment 
is quite a different one from that which we 
find in the books. One may say that as the ty- 
phoid fever process only, if not disturbed by 
art, Avill alloAV_ the phases through which it 
passes to appear in a certain purity, so under the 
hydriatic treatment, it presents itself free from 
complication due to accidents and unavoidable 
contingencies as a quite different being. On the 
one hand there is observed a general diminution 



of the severity of the symptoms, while on the 
other some of the symptoms are lacking alto- 
gether giving room to a series of new and nn- 
usual ones, and yet the picture in its totality 
shows all the characteristic features of the mal- 
ady indicating the nature and essence of the 
typhoid -fever-process, and corresponding to the 
facts of pathological anatomy. Even thus puri- 
fied and uncomplicated the disease allows us to 
recognize the signs of an intense blood-disease. 
The irritation of the brain and nervous system 
comes under observation, so do the pathological 
changes of the mucous membrane of the intes- 
tines and the lungs, the tumefaction of the spleen, 
the roseola and the exacerbations of the fever, 
but all in all the intensity of these symptoms does 
not exceed a certain lotv degree ivhich does not call 
forth any apprehension, and even the diminution 
of the body weight keeps within certain reason- 
able limits. To mention examples in advance, 
one fails to observe in cases under hydriatie 
treatment, those characteristics which allow the 
disease to be distinguished at first sight, such as 
the typhoid look, the stupid expression, the ^'de- 
composition" of the features, the bluish-red 
cheeks, the open mouth, the crusts on the lips, 
the sordes on the teeth, the dryness of the 
tongue, while the symptoms which otherwise de- 
termine the diagnosis of typhoid fever, such as 



^ 1:22 



the diarrhoea, the ileo-coecal gurgling and ttit^ 
more or less developed meteorism are not apt to 
reach a higher degree than that belonging to a 
simple intestinal catarrh. Thus it frequently 
happens that a typhoid fever patient with highly 
developed symptoms, when subjected to the water 
treatment, presents such marked changes in the 
character of the disease, that doubts as to the 
correctness of the diagnosis are very apt to arise 
in the mind of the attending physician. 

The modifications in the course and symp- 
toms of typhoid fever as brought about by the 
hydriatic treatment demand a change in the 
description of this disease, and, furthermoi-e, 
demonstrate that all those processes described 
under the head of complications and anomalies 
peculiar to the typhoid fever process are by no 
means necessary but sequelae only of unfortunate 
contingencies, which can be avoided by the sim- 
ple water treatment. And the very fact that the 
occurrence of these so-called anomalies can be 
prevented by simple external influences, supports 
the view that they are not an essential part of 
the typhoid fever process. If they were, they 
could no more be prevented from making their 

appearance than the other symptoms If 

the hydriatic treatment is carried out systematic- 
ally, severe hemorrhages, intestinal perforation, 
peritonitis, abscesses, mortification etc. are never 



— 123 

hiet with, excepting the case that complications 
existed before the water-treatment was insti- 
tuted . 

This powerful influence of the Water oil the 
typhoid -fever-process does not only furnish an 
interesting spectacle to the astonished observer, 
the patient also becomes cogni/.ant of the fact. 

The typhoid-fever-patient treated with 

water never is as sick as the one treated with 
medicines, never does his power of judgment 
leave him as entirely, that he should not be 
able to give information about his condition, or 
converse on the status of the disease and its re- 
quirement, never does the general weakness reach 
such a degree, to make it impossible for the pa- 
tient to execute such ordinary performances as 
changing his position in bed, eating, drinking 
etc. If I am not greatly mistaken, this remark- 
able fact makes the same impression on every 
physician as on myself. Each new case, and the 
daily observation furnishes so much of what is un- 
expected, and which differs from the customary 
picture of typhoid fever so plainly, that arti- 
ficial or fine means of observation for their 
observation are unnecessary. 

As far as the duration of the fever is con- 
cerned there is no marked difference between 
medical and hydriatic treatment, and I believe I 
was right, when in the first edition of my work 



^ 124 - 

I said ; that the duration of the disease proper 
does not differ materially whether one or the 
other method is employed. But the total duration 
of the disease is another matter. Under medici- 
nal treatment this lasts on the average 8-^10 
weeks, and even then the patients have not re- 
gained their old strength. Under hydriatic 
treatment the average duration is 40 — 45 days. 
An important shortening of the period of recon- 
valescence by means of the hydriatic treatment 
can therefore not be denied." 

Resume. 

1. Thecoldbathof 20— 15° C. (59— 68°F.) 
will reduce the temperature of the fever about 
1° C. (1.8 F.); after one-half to one hour the 
temperature will rise again. 

2. The effect is more pronounced in children 
than in grown persons, more in a late than in an 
early stage of the disease, more in mild than in 
severe cases, more after the treatment has been 
carried out some time than after the first baths. 

3. A pronounced reduction of the tempera- 
ture, while generally a favorable sign, must be 
accompanied by improvement in other symptoms 
to be of absolutely good prognostic significance. 

4. The cold baths will stop the rise of the 
temperature, and reduce the fever from day to 



„ 125 — 



day more or less rapidly according to the gravity 
of the case. 

5. The influence of the baths on the circa - 
lary or[;ans is, to make the pulse slower and 
stronger, check early hemorrhages, to bring back 
the tonus of the blood-vessels, to prevent or re- 
move the dicrotism of the pulse. 

6. Diarrhoea and meteorism are checked, 
coated tongue and dry lips will diaappear — the 
appetite and digestive functions are kept up by 
the baths. 

7. It is probable that an early and sys- 
tematic administration of the method will prevent 
ulceration in the intestines. 

8. The cool baths cause the secretion of a 
large quantity of pale urine of low specific grav- 

9. Sleep is produced, delirium, headache and 
restlessness are made to disappear, at times be- 
fore the temperature is lowered, coma and stupor 
ameliorated by the baths. 

10. The hydriatic treatment keeps the pa- 
thological processes within safe limits, thus 
making a mild case out of a grave one and 
making a mild case still milder. 

11. The water treatment does not shorten 
the duration of the disease excepting by pr^^ 



— 126 — 



venting complications and shortening the period 
of reconvalescence by means of preserving the 
strength of the patient. 



CHAPTER III. 



Indications and Method. 

Ill this chapter there Avill be discussed tha 
indications for the treatment after Brand, 
then the method of carrying out the treatment in 
general and in normal cases will be described, 
under this head the number, temperature dura- 
tion of the bath etc. will be considered, the next 
section treats of special condition, the treatment 
of children and older persons, (afterT. & B.). As 
far as the late critical and complicated cases are 
concerned, it was first my intention to say very 
little on this topic, and to refer the reader to the 
writings of Brand and Tripier and Bouveret. 
But inasmuch as the former are out of print and 
there may be not much to be found in the Eng- 
lish language on this matter, I have decided to 
treat this topic more extensively, particularly, 
as Dr. Brand was kind enough to revise, what he 
has to say on the treatment of the degenerated 
cases in his second edition, for this volume. On 
this to})ic I have given passages both from Brand 
and Tripier & Bouveret. The chapter ends witli 
a short section on hygiene, diet and medical 
tiou. 



The Three Indications. (Brand.) 

"The general iuclicatiou in the hydriatic 
treatment of typhoid fever is to combat the 
fever, to keep the daily temjDerature at an aver- 
age of 38.5 — 39°; the most appropriate means to 
remove and prevent the fever exacerbations are 
the cold bath. 

If this is repeated as often as the tempera- 
ture reaches 39°, it is possible to keep the patient 
almost in an afebrile condition, in consequence of 
which the organs carry on their functions in 
spite of the infection in an almost normal way, 
and the processes of nutrition (tissue changes) 
are carried on quite regularly. 

This indication holds good for all typhoid 
fever cases, inasmuch as the disease is always 
and everywhere the same. Xeither nationality 
nor climate nor sex, age, condition of life, indi- 
viduality, greater or less development of the 
progress make any difference, nor does the pres- 
ence of primary complications do so. Xever in- 
deed should a typhoid fever case be allowed to 
to suffer from the fever or its consequences even 
if heart, lung or other chronic diseases should 
complicate it. 

From this condition of things, there follows 
a number of principles, which each man who in- 



— 129 — 



tends using this method should make the guides 
for his actions. 

1. The hydriatic treatment of typhoid fever 
is not a remedy in the full sense of the tvord as e. 
g. Mercury against Syphilis, Quinine in intermit- 
tent fever. 

The effect of the hydriatic method is best 
named a prophylactic one. 

The fever if left to itself, produces new 
changes every moment, consequently the longer 
it lasts the greater must be their number and 
significance. 

The certainty of the result of the hydriatic 
treatment is therefore conditioned and limited 
by the time of its commencement and dependent 
on the greater or lesser development of these 
changes and their character. 

He, who is of the opinion that the hydriatic 
treatment might and must be able to help in each 
stage of the disease, is involved in deplorable 
error. Only when the harm which is done is of 
relatively minor impjortance, ivhen the fever only 
is still the important factor in the problem, aid can 
be expected and demanded from the hydriatic 
method in the later stages (jf typhoid fever . 

It is true there are cases on record, in which 
the effects of the hydriatic treatment have shown 
themselves in a later stage, in the time of great- 

9 



— 130 — 



est danger, when everything seemed lost. Mr. 
Behier has published such cases in the Bullet, 
general de Therap. June 15, 1874 as well as I 
myself in the present volume. 

For him, however, who is able to judge, 
there is no doubt that chance had a hand in these 
cases. But upon chance no conscientious phy- 
sician should rely. For the welfare of the pub- 
lic and the fortune of the hydriatic treatment it 
were better if such resurrections would not occur 
— they do no good and confuse the minds of the 
public. 

This first proposition furnishes the basis for 
judging all statistics pro and con, the hydriatic 
treatment drawing the lines accurately within 
which it can be made responsible for success and 
the contrary. On the other hand it counts for 
nothing those statistics which do not pay atten- 
tion to the real condition of things and the lim- 
its which have been pointed out. 

If e. g., as has been done, the cases which 
under medicinal treatment have assumed a grave 
form or in general the grave cases (in the latter 
stages) of any hospital are subjected to hydriatic 
treatment for the purpose of studying its effi- 
cacy, this is taking a^vrong view of the question 
under consideration. The hydriatic method is 
neither to be made responsible for these e)i funis 
perdus, nor does it exist to repair the damages, 



— 131 — 



which the mistakes and omissions of medicinal 
treatment have allowed to arise. 

If furthermore the results obtained from 
such cases are compared with those obtained from 
the mild cases not treated with water and thus a 
judgement should be formed on the water treat- 
ment which necessarily would not be in favor 
of the same, such judgment would be as false as 
it is unjust. 

The object of the Avater treatment is ex- 
clusively to force the disease into a normal 
course, and by keeping down the fever to pre- 
vent the degeneration of the process and the 
formation of complications. 

The consequences of tlie uncombated fever 
are not the object of the hydriatic treatment. 

2. The hydriatic treatment mad be carried 
out from the begiiDiinj/ (dc-s I e debut) of the disease 
to ins are perfect results. 

This demand of mine has been misunder- 
stood by many. The opinion has been held that 
this beginning covered all of the first week. 

This is not correct. The beginning of a 
disease which at times proves fatal on the third, 
fourth or fifth day cannot by any means be ex- 
tended to the eighth day. The beginning of 
typhoid fever is confined to the premonitory stage 
and the first three days after the occurrence of 
the chill. 



In 144 fatal case>. the hydriatie Tivatment 

ha> been commenced on the 

l<t day 0 time.-. 

2d U - 

8d 2 

4th 5 

5th 11 

with the increase of the day> the nnmher of 

deaths increased. 

If the hydriatie treatment i> t<> have perfect 

success, it must have i)een begun during the 

premonitory >tage or within the hi'st three days. 

The third day maybe included for rea.sous which 

^vill he nienti'jned htter. 

The ohjecti'Ui will he made, that typhoid 
fever case> do not come under observation at 
an early date. This is correct as far as the hos- 
pitals are concerned, liut not in private practice 
amongst the better clas.-e>. It is an exception if 
one is not called in the prodr^^mic stage or afieii 
the chill. The fureu'oing prn}insition will hold 
good particularly f<tr private practice. 

Another objection which has been made is 
that at this period the diagnosis i> not yet cer- 
tain. The c<'rrectnes> of this objection cannnt 
be dis})Uted. Init fhf" I'enj .<u-<picxoii of f^jpho^d 
fever "'n i inJic nfion for flu: hj/d riatir freat- 
meni . 



— 133 — 



If the further development reveals, that the 
case was not one of typhoid fever, so much the 
better. 

The former apprehension that a cold bath 
might be injurious in a case of pneumonia, of the 
acute exanthemata, of any febrile disease, has 
been converted into the knowledge that the anti- 
pyretic effect of the cool bath is as much to the 
purpose in these cases as in typhoid fever and 
that the indications for such treatment is as im- 
perative in the affections mentioned as in typhoid 
fever. 

A catarrhal or gastric fever under this 
treatment takes a much milder and for the pa- 
tient a much more pleasant form, than under 
ordinary treatment. 

Riegel writes on this point: '^As has been 
remarked the period of time, in which the patient 
comes under treatment is of the highest impor- 
tance for the success of the hydriatic treatment. 
Time and again one can convince oneself, that any 
given case will take a course the milder and 
quicker, the sooner the patient has been treated 
according to hydrotherapeutic principles, ^^'e 
therefore follow the rule to subject every case to 
cold-water-treatment as soon as the diagnosis of 
ty))hoid fever is certain. (A^ogl, who has achieved 
such splendid results, and even his house physi- 
cians, without any special orders, begin the 



— 134 



treatment even before the diagnosis is certain). 
I do not wisli to antagonize by this statement 
those, who use the hvdriatic method even before 
the diagnosis is beyond doubt. Such a course 
on the contrary is ^ fully justified, and Ave also 
subscribe to the principle that in any sickness in 
which the fever attains a considerable height or 
is of considerable duration the cold-water-treat- 
ment is not only justified but is one of the best 
antifebrile remedies at our command. For a 
long time we have convinced ourselves, that there 
is not the least harm done, if pneumonia and one 
of the acute exanthemata or any similar febrile 
affection is treated altogether according to hydro - 
therapeutic rules. It is not a rare occurrence 
that pneumonia, the acute exanthemata and 
other similar cases are treated with hydrothera- 
peutic processes in our clinic, of course only, if 
the high fever demands such an energetic pro- 
cedure. Xo reproach therefore can be offered 
to those, who use hydrotherapeutic procedures 
in a stage, when the diagnosis of typhoid fever 
cannot positively be made, inasmuch as no dan- 
gers follow this method in cases attended by high 
fever." 

3. Everij casp of fnphoid frrpr. icJipfher grare 
or in lid, is to Jir fyprifed u'ifJt tvofer. 

The I'easons for thisdemaiul are. that in tlie 
])eginuing of a case of tvplioid fc^ver nobody can 



— ;i35 — 



know, whether it will take a mild or severe 
course ; — that the certainty of success becomes 
doubtful at the time, when such a distinction can 
be made (eighth to twelfth day) and that even 
for a mild case of typhoid fever the hydriatic 
treatment is the most useful. 

To my astonishment I see that this funda- 
mental principle has been vigorously attacked in 
France. In Germany (Wunderlich) it has not 
been followed, but attacked it has not been by 
any one. 

Mr. Libermann, physician to the military 
hospital Gros-Caillon in Paris has adduced the 
the following objection: (Union medicale No. 97 
etc. 1874). ''The whole world knows," says 
Lihermann, "that of 100 cases of typhoid-fever 
80 will recover. 

Of 100 cases during an epidemic 50 — 60 
are mild ones, which recover without any treat- 
ment, excepting the use of hygienic measures. 
Therefore in one case out of two and in certain 
times in two cases out of three the baths are use- 
less. 

The first indication then is to observe it for 
the grave forms. 

But by which means can we arrive at a con- 
clusion as to the gravity or the benign character 
of a case of typhoid fever before the alarming 



— 136 — 



symptoms appear in connection with lesions of- 
ten irreparable? 

In the first week it is altogether impossible 
to know, whether the fever will be grave or be- 
nigne, but about the eighth to twelfth day one 
can reach a conclusion with a sufficient degree of 
probability. In this period it is time enough 
to commence the treatment and to obtain all the 
good effects which it will yield." 

To this the objection may be made, that the 
idea of confining the hydriatic treatment to the 
grave cases has its full justification. I am fa- 
miliar with it. Twelve years ago I wrote in my 
pamphlet (Zur Hydrotherapie des Typhus, Stet- 
tin 1863) the following: Grave cases of typhoid 
fever must be treated with water in order that 
one may be without apprehension on the issue of 
the case. There are however a multitude of 
cases of a milder form, which, as I am well 
aware of, do not require such energetic treat- 
ment for a happy issue, which, inasmuch as they 
recover spontaneously, are not in need of any 
medical interference. But who knows of any 
reliable sign, in the beginning of a case of ty- 
phoid fever, that will insure a mild course 
Who does not know that apparently mild cases 
suddenly assume a grave form ?" 

Between Lihenvana and myself then, any 
one can see, there is the fullest harmony of opin- 



ion, that the 20 percent which amongst the 100 
cases under ordinary treatment end fatally are 
the proper object for the hydriatic treatment, and 
further, that in the first week it cannot be as- 
certained, whether the course of the disease will 
be a mild or a grave one. 

Regarding, however, the other points, 
whether one can depend on a favorable outcome, 
if the treatment is begun after the eighth day 
and whether the cool bath in a mild case is use- 
less, — in this matter our opinions are greatly at 
variance . ' ' 

Quoting statistics that show that death is 
rare if treatment begins before the fourth day 
and that the mortality increases with each day 
that the treatment is begun later, Brand adds : 
''The assertion that one is allowed to defer the 
water treatment until after the eighth day and 
that the result is certain then, cannot be sus- 
tained and its incorrectness cannot be better il- 
lustrated than by such figures."' 

With the third or the foarth day the pluj^ickut 
looses control of the disea.^e, ivJnch henceforth takes 
the course it choosei<. 

Statistics show, that amongst 8141 cases 
two cases died, which came under treatmant ou 
the third or second day. One died the same day, 
the other unwell for eight days and confined to 
bed one day presented such mild symptoms, that 



- 1^8 — 



baths hardly have been given. I believe there- 
fore, that both can be excluded and that the 
third day fixes the limit beyond which one should 
not wait to begin with the treatment. 

If treatment is begun nnthin this period one 
can in general depend upon that the patient tvill 
recover, inasmuch as it .^eems that complications do 
not occur.'' 

Presenting a table showing the day on which 
the water treatment was commenced and giving 
the complications and their number, Brand 
adds : ^'The earliest point of time in which the 
water treatment was begun to be followed by 
complications was the sixth. 

All other cases which came under treatment 
earlier took a normal course, ivithout complica- 
tions, and in the course of eighteen years I have 
never seen any pneumonia or in testinal hemorrhage 
develop under these conditions. 

This fact is of the highest significance throw- 
ing a flood of light on the mode of action of the 
hydriatic treatment . 

Not recognized by other observers they 
have a presentiment of it, for all aflirm, that the 
results are the more certain, the earlier the 
treatment is instituted. 

In fact everybody who wants to treat ty- 
phoid fever with peace of mind and without re- 
proaches and who wishes to have reliable results 



— 139 — 



will haye to satisfy this fiiDdameiital principle j 
and emancipate himself from the erroneous opin- 
ion, that mild symptoms in the first stage of ty- 
phoid feyer will allow a procrastination in the 
application of the method. The yery worst, the 
insidious cases, (Ziemssen) are apt to begin with 
low temperatures and mild symptoms, when 
suddenly irrejaarable sequences follow. In seyen 
of my fifteen fatal cases the physicians who had 
been treating the cases preyiously excused them- 
selyes for neglecting the method by the ap- 
parently mild course of the disease. 

Necessarily this principle has its limitation 
in the circumstance, wether it is possible that 
the patient be treated according to the method. 
In priyate practice this would seem possible, not 
howeyer, in hospital practice. 

Mr. Liberrnann calls the bath useless in mild 
cases. 

My honored colleague has perhaj)s neyer had 
typhoid feyer himself, and not experienced how 
unpleasant eyen such mild forms are for the pa- 
tient. The lassitude, the headache, the feeling 
of oppression and the decubitus produce suffer- 
ings seyere enough. 

And to bring relief here the matei'ia medica 
furnishes no remedy. 

The cold full-bath howeyer, or still better, 
the luke-warm half-batli with cold affusions of 



— 140 — 



.such short duration that no chill occurs, of ten 
minutes duration, two to three times daily, (a 
more frequent repetition the fever does not de- 
mand) will soon put a different face on the sick- 
ness. With each affusion the feeling of oppres- 
sion will disappear, so that the patient cannot 
get enough of the affusions, the strength soon 
returns and instead of the weaknes a genuine 
cupJioria returns. A patient treated in such a 
way need not even remain in bed. but can rest 
on his couch in the open air, he reasons, con- 
verses, eats as under normal conditions and is 
allowed to smoke if he should choose to do so. 
The course of the disease is shorter, the strength 
is preserved and further infections are rare. The 
physician, the family are spared work, care, 
grief, sorrow, and such a remedy for which I can 
claim all these things from personal experience 
is to be called useless?'" 

Execution' of the ^Method tx Xoemal 

C\\SEs. 

It is not the purpose of tlie autlior to enter 
into any theoretical questions concerning the 
physioh:)gical modus operandi of the hydriatic 
method. ^ But for practical purposes one may 
distinguish the following two nuiin effects : the 
antipyretic and the stimulating. One might also 
call the cool-bath-treatment a protective method 



— 141 — 



meaning by this? that through the inliuence of 
the often repeated baths, the different organs are 
guarded and shielded from the injurious in- 
fluences of the poison, so that the pathological 
changes induced by the same, remain within safe 
limits, allowing the organs affected to swing 
back to their healthy normal condition after the 
poison has done its work. The reduction of the 
high temperature is certainly one of the most c^. r- 
tain and useful effects of the hydriatic method. 
Although the observation that typhoid fever of 
grave form may run its course without any ele- 
vation of temperature, has demonstrated that 
high temperatures are not the only dangerous 
pathological condition, yet in ordinary practice 
high tejnperatures furnish, if not in themselves 
dangerous, a reliable indication of how the tis- 
sues and organs of the body are affected by the 
poison. It would seem further not illogical that 
if a method of treatment has the power to bring- 
back the heat-regulating organs to their normal 
condition it may have a similar influence on some 
of the other protoplasmic structures just as im- 
portant to the maintenance of life as, the res]nra- 
tory centre, the nerves governing the heart and 
those regulating the flow of the blood and the nutri - 
tive fluids of the body. In his first edition Brand 
points out the ''stimulating" effect of the bath 
before mentioning the antipyretic. As a matter 



of fact the beuelieial effects of the bath can of- 
ten be observed before the reduction of the tem- 
perature has been accomplished. 

The increase of the amount of urine may 
further be of aid in removing rapidly from the 
system the products of retrograde metamorphosis 
and the poisonous substances produced directly 
or indirectly by the morbific agents, and the af- 
flux of blood to the skin after the bath may re- 
lieve internal organs from congestions. We can 
thus speak of a derivative effect of the baths. 

Brand's method. Describing this I shall 
give the words of Tripier and Bo are ret, with 
some unimportant omissions, so that the practi- 
tioner may have the best authority, if he should 
be inclined to try the method. 

•^Since his first publication Brand en- 
deavored to combine the most simple and most 
effective procedures of applying cold water to 
meet as thoroughly as possible the fundamental 
indication : to keep during the entire course of 
the disease the body temperature at a moderate 
degree, and all the organs in a condition allow- 
ing them to carry on their normal function. In 
his second edition of 1877 he recommends in- 
stead of the cold affusions in the luke-warm 
bath, which he had been using formerly, the cold 
full bath. The general formula now is : A cold 
hath of' 20° C. (68°F. ) and of 15 minutes dura- 



— 143 ~ 



tton every three hoars as long as the temperature 
of the patient reaches 39° C (102.2 F.) in the rec- 
tum. This formula is applicable in the majority 
of cases. It is however not absolute and has to 
be modified according to the individual condi- 
tion of the patient, depending on the intensity 
of the fever, the stage of the disease and the na- 
ture of the complications. 

Execution of the Method. 

The cold f nil hath. The quantity of water in 
the tub must be sufficient to cover the patient up 
to his neck; this is often neglected. It is nec- 
essary that the chest should be completely cov- 
ered. Before each bath the temperature of the 
water is to be tested by the thermometer and 
warm or cold water to de added as the case may 
be. It is not necessary to renew the water for 
each bath, if not contaminated by the patient, it 
will not require a change for one to two days. 
The tub is to be placed alongside of the bed at 
a distance of three to nine feet. 

The patient steps into the bath himself or 
is lifted into it. The unpleasant sensation of 
passing into the bath may be ameliorated by 
sprinkling the face and chest with water colder, 
than that of the bath. If the patient is weak 
or not far from fainting, he may receive a glass 



— 144 — 



of wiue before entering the batli. (I alivai/s give 
a glass of punch, coffee, Avine. whatever the pa- 
tient may prefer, before he enters the bath. * 

In the course of the bath affusions to the 
head are always to be made: they are always 
useful and necessary in cases with grave nervous 
symptoms. Brand recommends three afftisions 
of two to three minutes each, one at the begin- 
ning, one in the middle, and one at the end of 
the bath. We prefer to use those affusions al- 
most continually throughout the bath. In mild 
cases the watei* out of the tub may be used, in 
cases with nervous complications colder water is 
to be preferred, the colder the more intense the 
delirium and the deeper the coma. A vessel 
provided with a spout or an ordinary sprinkling - 
can will answer the purpose. The hair is to be 
cut. If a female patient does not wish to sacri= 
fice them, they liave to be plaited and pinned 
up. although the cutting off would not be much 
of a sacrifice inasmuch as the hair will fall out 
even if the water treatment is carried out sys- 
tematically. During the att'usion the water, 
while running down the face and entering 
eyes nose and mouth prodtices unpleasant sensa- 
tions: this may be prevented by placing a folded 
pocket-handkerchief around the head, knotting 
it behind: the water which is poured on the head 
will now run down behind over the back of head 



— 145 — 

and neck. The aft'usions are made slowly but 
plentifully. 

Brand recommends also to rub the chest and 
limbs (Vogl advises a large sponge) with 
the hands while the patient is in the water. This 
operation is not as necessary as the affusions, but 
may be of service during delirium and coma. 
In the middle of the bath the patient drinks a 
glass of cold water. 

Not unfrequently especially at the begin- 
ning of the treatment the patients make com- 
plaints, are restless and ask for the discontinua- 
tion of the bath, as a rule the physician is 
present at the first bath ; he has to quiet the pa- 
tient and encourage him wnth kind words to hold 
out. 

The bath lasts 10 — 20 minutes. In grave 
cases w4th high resistance to the reduction of 
temperature the patient is allowed to feel chilly 
in the bath for a few minutes. kSoon his whole 
body shivers, his teeth chatter and the patient 
complains considerably about the sensation of 
cold which he experiences ; this is a sign that 
the central temperature begins to fall. 

According to the strength of the patient, he 
either steps out of the bath or is lifted out. He 
next is dried off ; put to bed and his legs up to 
his knees are wrapped up in a woolen blanket. 

10 



— 146 — 



If he complain^ luucli of the coldness a jug of 
hot water is ph\ced against his feet. The rest 
of the body in summer is covered with a linen 
sheet, in winter with a double woolen blanket. 
We often have seen badly instructed nurses 
wrap up the patient in wollen blankets and throw 
more over him while in bed. This is bad prac- 
tice, only lessening the full beneht of the bath. 
It is well for the chill to continue some time 
after the bath. During the fever our patients 
Avear nothing but a shirt, during the stage of 
defervescence or reconvalescensc we order woolen 
under clothing if such has been worn before. 

Twenty to thirty minutes after the bath the 
temperature ought to be taken again, which is 
necessary to gain a correct insight into the effect 
of the bath, and for conducting the treatment. 
The introduction of the thermometer is attended 
with little difficulty, if the j^atient, after coming 
out of the bath is placed on his side, a position 
which he is apt to assume spontaneously as soon 
as his condition is improving. 

After the cessation of the chill, the patient 
feels very comfortable. This happens about 
15 — 20 minutes after the bath and is a very con 
venient moment for the administration of nour- 
ishment; consisting of thin soup (broth, milk) 
some pure water, or water mixed with wiiie. 



— 147 — 



Quiet now reigns, and sleep often sets in, which 
ought not to be disturbed, neither by noises nor 
unnecessary visitors. 

Cold compresses. Brand notwithstanding the 
criticism of JurgensenYv^^ retained the cold coin - 
])resses aj^plied to chest and abdomen, covering 
them from side to side as much as possible con- 
sisting of linen cloth folded four times and 
slightly wrung out of water of 10°C (50°F.) 
The applications are to be changed every five to 
fifteen minutes according to the intensity of the 
fever. When, however, the patient sleeps 
quietly, he is not to be disturbed on their ac- 
count. In the beginning of our observations we 
were in the habit of making these applications 
regularly. Later on we omitted the compresses 
on the chest, which on the whole seemed useless 
to us. The applications to the abdomen we re- 
tained, inasmuch as that seemed very useful and 
efficacious, using them from the beginning dur- 
ing the whole period of the fever, especially in 
grave cases. It is important that these applica- 
tions be changed frequently (sufhciently to keep 
the surface of the body from becoming warm to 
the touch) and the nurses have to be watched, 
so that they execute this part of the method ac- 
curately. To protect the bed from moist uie, oil- 
cloth (or flaunefs) must be laid over the com- 
presses. 



— 148 — 



Temperature of the bath. This varies AAdth 
a inimber of circumstances, amongst which the 
most important is the intensity of the fever and 
the resistance it offers to the cooling process. 
There are, however, limits which should not be 
transgressed. BrcDid mentions 15 — 20° C. (59 
— 68°F.) as the limits between which the tem- 
perature may vary according to the case. 

Brand correctly rejects the baths of a very 
low temperature being very unpleasant, and not 
well borhe by the patient. They may perhaps be 
applicable in the rare cases when the fever re- 
sists the baths of higher temperature* As sta- 
tistics show baths of 15 — 20° give better re- 
sults than the colder ones ; on the other hand 
it will not do to go to the other extreme of a 
too high temperature, inasmuch as statistics 
have shown that the luke-warm baths do not 
give very good results. (To humor the patient 
and his friends, I have generally commenced 
with a luke-warm bath of 85 — 90° F., adding 
no more warm water to the following baths: 
the temperature will thus after a few baths, 
C(une down to the desired degree. In actual 
practice such yielding will amply repay itself. 
Brand furthermore recommends this method.) 

The maximum of the teni|)erature is to be 
20° C, with this temperature one ought to begin . 
Th(^ reduction produced is a measure of tlie 



efficiency of the bath, and varies between 0.2 — 
2"^ C. (0.4—4° F.) At times no diminution at 
all or even an actual increase takes place. In 
general the reduction ought to amount to 0.8— 
1° C. (about 2° F.) if the bath has produced a 
useful result. In case that the average reduction 
of the first baths of 20° is less, the temperature 
of the bath must be reduced to 15°, in as much 
as the effect of a bath of 17° is hardly better 
than that of 20°. This is the practice which 
Brand recommends. 

We also as a rule have followed the same; 
nevertheless we often have made use of temper- 
atures above 20° (68° F) and even as high as 24° 
(75° F). We distinguish, as far as the temper- 
ature is concerned, three kinds of baths: one of 
22—24°, one of 18—20°, one of 14—15°. (Con- 
sidering the lack of accuracy of ordinary ther- 
mometers for practical purposes w^e may translate 
these figures into (70—75° F.) — (65—70° F.) 
(60 — 65° F.) which numbers would also be easy 
to keep in memory.) The first frequently is 
sufificient in mild cases, in many of medium 
gravity and in the later stages of the majority of 
grave cases, to produce the necessary reduction 
of 1° C. (2° F.) In a similar way as the luke- 
warm bath, gradually cooled down, this kind is 
adapted to weak and low' patients, the adynamic 
forms and in case heartwxakness should be pres- 



ent. The bath of 18—20° (65—70° F.) which 
we ordinarily apply, is applicable in the great 
majority of grave cases. Xevertheless, during 
the combat with the fever, when the resistance 
to the cooling process is very stubborn for a 
number of days, at least in the evening, baths 
of 14—15° C. (60—65° F.J) have to be employed 
to produce the reduction of 1° C. (2° F.) To 
reduce the temperature of the baths, in case the 
desired result should not be obtained, is a very 
important rule. 

Very high temperatures do not always re- 
quire equally cold baths. AVe have seen baths 
of 22° C. (72° F.) produce reduction of 2 — 
2.5° C. (4 — 5° F.) where the fever stood at 
40.5 (105) and higher. When collapse is threat- 
ening, the fall of the temperature may be even 
more. It is best therefore to experiment a few 
hours or days, to be able to judge of the resist- 
ance by the reduction, which is obtained by the 
first baths. A safe rule then is to begin with a 
bath of 24° C. (75° Y.) and if the results are not 
sufficient, to reduce the temperature according to 
the resistance of the fever to 20° (68°) 18° (65°) 
and even 15° (59°), until the average reduction 
of 1° (2°F.) is produced, which is the normal ef- 
fect of a cool bath. 

FreqHeHcy of the baths. Interval between 
the baths. Baths daring the night. The general 



— 151 ~ 



formula demands a bath every three hours, or at 
least, that one should convince oneself every 
three hours, that the temperature does not ex- 
ceed 39^ (102.2° F.). This rule however does 
not always hold good. While, as a rule, the 
effect of the bath lasts from tw^o to three hours, 
this may not be the case in the beginning oft the 
disease, and in grave cases, when the reduction 
of temperature may be of but short duration. 

The question then arises: are we to bathe 
oftener, when the temperature rises rapidly after 
the bath? Brand is of the o]3inion, that the 
number of the baths should not be increased 
indefinitely; and that 8 baths in 24 hours are to 
be the maximum, which ought not to be exceeded. 
If there should be an early rise of temperature 
between the two baths, the injurious consequences 
of this may be nullified by a prolongation of the 
bath and by a lower temperature of the same, 
producing thus a deeper and more lasting remis- 
sion. 

We are however of the opinion, that often 
it is not only useful but unvoidable to bathe 
oftener than every three hours. In grave cases 
the single bath can not be given cold enough, 
nor can it be prolonged sufiiciently, partly be- 
cause the patient, on account of weakness, can- 
not endure a prolonged cold bath, partly because 
the attendants cannot make up their minds to 



— 152 



keep liim in the cold water long enough. In 
such cases the insufficient quality of the bath has 
to be compensated by their number, and every 
two or one and onehalf hours the same have to 
be repeated. — AYe have met such a case in 
country-practice: 9th or 10th day of sickness, 
adymania, deep stupor , very high temperatures, 
it is impossible to to keep the patient in his bath 
longer than 6 — 8 minutes, and to take the temper- 
ature of the water below 20°. We therefore had 
to bathe the patient every one and onehalf hours 
— later on every two hours. This modification of 
the treatment produced a good result ; after two days 
the high fever had abated and the stupor was 
much diminished. 

In some grave cases or such of medium 
gravity it may happen that the reductions about 
the 15th or 20th day are sufficient or even very 
pronounced, and that nevertheless the eight 
daily measurements will show the temperature 
immovably high, 39.5°, 40° and even higher. 
Here the resistance to the cooling-of -process 
shows itself in the tendency, rapidly to get back 
to the apex of the fever curve. This course of 
the fever can readily be combatted by increasing 
the number of baths, giving them every two 
hours, even every hour. 

An example for this special form of resist- 
ance to the cooling process is the following: A 



153 — 



Toimg; typhoid fever patient, who had been 
bathed since the fifth day, had reached the 18th 
day of a grave form of the disease. Each meas- 
urment shoAved the temperature to be 39. 5^^ 
(103 F.), and 40.5° (105 F.) in the evening, 
although each bath of 20°, and 5—10 minutes 
duration easily reduced the fever 1.5 to 2°. 
(3— 4°F.) Taking measurements every 30 minutes 
showed, that the strong reduction was of short du- 
ration, inasmuch as one and onehalf hours after 
the bath the fever rose to it sold height. We now 
ordered a bath every two hours, upon which the 
diarrhea decreased and the general condition im= 
proved, the temperature but rarely rising above 
39°, and generally remaining between 38.5 and 
39°, thus allowing the patient to omit the ma- 
jority of the morning baths during the next 
day. 

To discontinue the bathing during the night 
under the pretext, not to disturb the rest of the 
patient by the baths, is not correct, according to 
Brand; restlessness, sleeplessness, subsultus ten- 
dinum, not being sleep. The right kind of rest 
is that follow^ing upon the bath; 12 baths in the 
course of the day are not sufficient to compensate 
for the detrimental influences, which an inter- 
mission of the baths during the night produces. 
The aim one ought to have in view% and which 
is to be reached as soon as possible, is: to keep 



the patient night and day in a condition of a 
relative, a-pyrexia. In the hrst half of the 
night or at midnight there often takes place such a 
high rise of the fever, that all the typhoid-symp- 
toms are apt to recur. Brand adds, that the 
intermission of the treatment during the night 
increase the resistance, which the patient will 
offer to the cooling-off -process during the fol- 
lowing day. Finally the night-baths have this 
advantage : they aid in making more pronounced 
the decrease in the fever, which is apt to begin 
spontaneously about midnight. As we have 
seen ourselves, the greatest thermic remissions 
are apt to be produced by the morning baths, 
and the baths, which can be passed over, are 
generally those between 3 and 9 A. M. 

Duration of the hath. The general duration 
of the bath is 15 minutes. It i> shorter in the 
case of children and aged persons. Xevertheless 
it is not always the watch in hand, which tixe> 
the duration of the bath. Xo doubt, a cold and 
short bath of 3 — 4 minutes duration can produce 
the stimulating and derivative effect. This 
however is not the only and (perhaps not) the 
most important effect of the bath. The anti- 
pyretic effect only takes place, where the cold 
water proves itself victorious against that resist- 
ance, which the fever opposes to the process of 
refrigeration. This moment is indicated by the 



155 — 



occurence of the chill. Even the first immerslou 
into the cold water produces a shivering and 
chilling of the- whole body, this however is not 
the true chill. This sets in a good ^deal later, 
generally 8 — -12 minutes later. It is more pro- 
nounced. The earlier or later beginning of the 
chill depends uudoubtedly on the resistance to 
the refrigeration , and this again on the temper- 
ature of the bath. Therefore it sets in early in 
the very cold baths of Jurgensen and late in the 
lukewarm baths. 

The chill then is as a rule the signal, that 
the central temperature is beginning to sink. 
There does exist even a certain relation between 
the chill and the decrease of the fever, as ascer- 
tained 15 minutes after the bath, and the latter is 
the more marked, the longer the chill lasts. 
(Glenard.) 

There is no doubt, that in many mild cases 
and in others of medium gravity the cold bath, 
if interrupted at the beginning of the chill or a 
few minutes later, will produce a fall of 0.8 — 
1° (about 2° F.) but in grave cases, where the 
temperature is very high and the resistance very 
strong, the bath must continue some minutes after 
the chill has begun. (I think that but for very 
good reasons it is best to adhere to the 15 minutes 
of the fornmla, at least until experience in the 
individual case has demonstrated a shorter time. 



— 166 ~ 



to be .siiiiieieiit. VogPs rule is: '-an earlier 
removal from the bath is permitted only, when 
111) usual pallor, or a cyanotic color of the face 
should show itself, or during marked dyspiasea'' 
conditicms, which amongst the thousands of baths 
have been of rare occurences.) 

How often are the hafhs to he repeated f For 
Jiir(jense}i 40° (104° F.) furnish the indication 
for a new bath; for Brand 39°C.(102.2F.)Forthis 
rule Brand gives the following reasons: 

(1) AVhereas the rule to bathe at 40° is 
sufficient far the mild cases and those of medium 
gravity of normal typhoids (80 percent of the 
cases J this is not the case in the grave and de- 
generated forms (20 percent). Nearly one half 
of these cases run their course at a lower tem- 
perature, and the very gravity of the case would 
seem to be the cause, why the temperature 
remains at a medium height. Inasmuch then, 
as there are no means of telling, whether the low 
temperature signifies a mild or a grave form, 
nothing remains, but to take the temperature 
low enough for demanding a bath to include the 
grave cases attended by a low temperature," 

(2) (As far as the number of baths is con- 
cerned.) '^I (Brand) am of the opinion, that it 
is not to be forgotten, that the organism to be 
treated is a human one, and that it should not 
be taxed more than necessary. The number of 



baths pi'o die should be a limited one and should in 
general not exceed 8 in number. Inasmuch as the 
effect of a properly executed bath on temperature, 
pulse, nervous system, the excretion of carbonic 
acid and urea as a rule lasts 2J — -3 hours, a bath 
every 3 hours, in my opinion, is as much as 
should be demanded from the diseased organism. 

(3 J According to my theory of the typhoid - 
fever-j^rocess it is the apyrexia which the baths 
aim to produce. A condition of 40° cannot be 
considered as one free from fever. The highest 
limit should, in my opinion, be 39° (102.2 F.). 
If at this degree of body-temperature baths are ad- 
ministered, the temperature of the body is for f of 
the time so near the normal, that one can look at 
the condition of the patient as one of apyrexia. — 
If the point for bathing is fixed at 40°, it wiJl 
be found upon inspecting the average daily tem- 
perature-curve, that the same, instead of steadily 
sinking and finally remaining between 38 and 
39° (100.5—102.2° F.) will always stay above 
the latter figure and have a tendency to rise 
above 40° (104 F.j and will often go beyond 
this figure. Such a behavior of the temperature 
Avill not furnish the necessary protection against 
the dangers of the typhoid-fever-process." So 
far Brand. 

"The limit of 39° however is not irrevocable 
or axiamatic. During the j>eriod of defervescence 



— 158 — 



it may happen that even at the evening exacer- 
bations the temperature does not reach 89°. In 
such case it is ^vell to give 1 — 2 baths at night of 
22 — 24° no — 75 F. about ^ to procure a good 
nights rest and t*,) hurry on the defervescence and 
to insui'e reconvalescence. Finally it is well in 
grave cases particularly, when during the period 
of defervexence the curve of the averages of the 
maximum has assumed the wave-like type, to 
take 38.5° (101.7 F.) as the indication for a new 
bath in order to avoid a recrudescence of the fever. 

The riiioinefrlcu.l /nta-^f( re//i^/ds. For a meth- 
odical execution of the cold-water-treatment of 
typhoid fever thermometrical measurements are 
necessary, if not desirable. As a rule IH <uch 
measurements are necessary. 8 before and 8 after 
the bath. ( In private praxis 2-3 measurements 
per day after the bath seem stitiicient to me. 
S. ) In some particularly grave cases, when 
e. g. it is necessary to bathe the patient 
every two or one and one half hours, or when it 
is desirable to be informed concerning the 
course <:)f the fever in the interval> nf tlie baths, 
the temperature has to he taken every i — 1 
h(uir. Towards the end of the treatment such 
fre(pient jneasure]nent> are unnecessary, one in 
the morning and one at night l)eing sufficient. 
It is indilferent which hours are chosen foi- tak- 
ing the temperature, we advise however the fob 



— 159 — 



lowing: 12 o'clock midnight, 3, 6, 9 o'clock A. 
M., 12 o'clock noon, 3, 6, 9 P. M. — Hoav 
long after the bath ought the temperature to be 
taken to judge of the efficiency of the bath ? 
\yithout doubt at the time of the deepest descent. 
This moment however varies according to dif- 
ferent circumstances. As a rule the mercury 
will be falling for 20 — 30 minutes after the 
bath; after this time the chill generally will 
have ceased and the patient sleeps. It would 
certainly be harmful for the patient to keep back 
or interrupt this sleep, even for the purpose of 
a necessary measurement. It is therefore best 
to take the temperature 15 minutes after the 
bath. It is important to use with the same 
patient always the same interval to make com- 
parisons more perfect. 

The attendants keep a record of measure- 
ments, so that the physician can get an insight 
into the course of the disease, the effect of the 
treatment and the thoroughness, with which this 
has been carried on during his absence. 

The frequency of the therm ometric measure- 
ments has been critizised, and has been used as 
an argument against the Brand method. Ex- 
perience however teaches, that in hospital and 
})rivate practice sucli measurements can be car- 
ried out as often as re([uired. In case the use 
of the thermometer should be absolutely imj)os- 



— 160 — 

sible. the heioht of the fever can be reasonably 
determined by certain other signs, a red face, 
dry tongue; thirst, head-ache and sleeplessness, 
grave nervous affections. The red cheek is of 
considerable value. ( indicating often an exacer- 
bation). As long as the temperature is below 
3f^" the color of the face generally is normal, if 
it rises however over 39°. and remains there 
>ome time, one or both of the cheeks are apt to 
be covered by dark-red color. Aside from the 
gravity of the symptoms, the measurements, 
which the physician himself makes during his 
visit and the result of a 1 — 2 days water-treat- 
ment will allow a judgement to be formed on 
the intensity of the fever. We knom from 
having treated numerous patients after Brand 
that we have a grave case under our care, if 
after having been bathed continuously, the patient 
at the end of the first or the beginning 
of the second week, will not pass over a bath 
and must have his bath every three hours, while 
in milder forms of the disease or near the end of 
the illne>s he will be much more apt to omit 
some of the l)aths. We know further that the first 
baths that can be omitted are generally the 
morning bath> i8 — 9 A. M."). According to 
this condition a physician in the country can use 
the method without exact thermometric measure- 
ments. Nor is it necessary to take the temper- 



— 161 — 



atiire of the water with an instrument, it can be 
estimated by means of the hand. (I cannot 
imagine that a physician any where will have 
any trouble to have his fever- or bath-thermom- 
eters used intelligently by his patient. There 
are a good many broken of the former, but as 
they are now comparatively cheap, this is no 
longer such an important matter.) The measure- 
ments in the rectum are much to be prefered to 
those in the axilla; they are much more accurate, 
3—5 minutes are sufficient. 

Of course it is important that the physician 
should control the work of the attendants by 
taking the temperature himself (or having it 
taken during his presence) once a day. The 
thermometer should be dipped in some lard etc. 
every time before being introduced. 

Cessation of the baths. In general the bathing 
can be stopped, when the temperature at no time 
of the day reaches 39^ (102.2 F.) The cases 
which have been treated methodically are now 
in the period of defervescence and relapses are 
not much to be feared. Especially in cases of 
medium gravity it is to be recommended to con- 
tinue the use of the bath even if the temperature 
of 39° is not reached any more. Thus a bith of 
22—24° (71—76 F.) of 5—6 minutes duration 
can be given every time the temperature rises 
to 38.5° (101.7° F.) especially if the fever rises 

U 



rapidly after tlie bath. Quinine is often of use 
in this later period. Still later 1 — 2 baths look- 
warm or cool towards evening are useful." — . 
So far T. & B. 

There are, besides the cool bath, two other 
methods, which ought to be mentioned as being 
useful under certain conditions: (1) the luke- 
warm half -bath with cold affusions, which was 
the method originally employed by Brand and 
(2) the method of Ziemssen, 

The cold afftislons in the luke-ivarm bath 
are executed thus: There are to be 5 — 6 inches 
of water of about 85° F. in the bath-tub, 2 or 3 
pails of cold water, of 50 — 65° F. are standing 
ready at hand. 'The patient is supported in a 
sitting position in the bath, and moistened and 
rubbed with the water in the tub. Next the 
Avater in the pails is poured with a pitcher, 
sprinkling can etc. oyer the patient in such a 
way that it will run oyer his occiput and back : 
it ought not to be poured from any considerable 
height. After 2 — 3 minutes the procedure is 
repeated, the patient being rubbed down thor- 
oughly all the time. The whole procedure is to 
last from 3 — 10 minutes. — This form of the 
bath has more of the stimulating than the cool- 
ing properties and is therefore applicable in cases 
where the reduction of the feyer is easily ac- 
complished and other symptoms demand the use 



— . 163 



of the water, as in cases with normal temperature, 
or moderate fever, the ^'degenerated" and com- 
plicated cases that come under treatment in a 
late stage of the disease. 

Ziemssen's method. Here the patient is placed 
in a lukewarm bath, about 5 — 6°C(95^F.) below 
the temperature of the body, the bath lasts about 
20- — 30 minutes and the temperature at the end 
of the bath is to be 20° (68° F.). Cold water is 
to be added to the original bath until the lower 
temperature which may be desired is obtained. 
A bath of this kind must last 30 minutes to pro- 
duce the same effect as the ordinary bath of the 
formula, and in grave cases it does not seem to 
be as efficient as this. This bath has its use in 
the treatment of elderly persons, of very weak 
persons, in a late stage before more active meas- 
ures can be used, in heart and lung complica- 
tions, and as an excuse for something better. 
But statistics do not show as good a result from its 
use than from that of the classical bath. 

Both of these methods suffer from the 
drawback, that hot water has to be used. While 
for 1 — 2 baths a day this may not be of much 
consequence, for a large number of baths this 
would be the case to such a degree, to become 
a serious hindrance to an extensive introduction 
of the method in private practice, — on account the 
labor, of the noise and turmoil, which the carrying 



— 164 — 



to and fro of the water, the pouring and heating 
of the same will make necessary. 

Execution of the Method Special Types 
AND Conditions of the Disease. 

Grave cases and cases of medium gravity. 
As might be expected from the second chapter 
that period, during which the combat with the 
fever is in progress, is of the highest interest in 
the grave cases and those of medium gravity. 
On the more or less thorough way in which this 
battle is carried out the further course of the 
fever, the presence or absence of complications 
and even the final outcome will depend. — The 
truly hyperthermic forms, which furnish the 
greatest resistance to the water-treatment are the 
very ones where one must not follow the letter but 
the spirit of the method. The desired end will 
often not be reached by the formula. After 8, 
10 or 15 clays the temperature will of course go 
dowai, but this is too late for the organism, 
which is exposed to a high, permanent and insuf- 
ficiently combated febrile condition. 

If from the first days of the treatment the 
temperature-maxima (before the bath) are all 
40° (104° F.) or more in the morning and reach 
and exceed 41° (105.8° F.) in the evening, the 
resistance to the refrigeration is of a high degree 
and the condition is critical. Under such con- 



— 165 — 



ditions the general formula will produce but a 
very moderate fall of temperature or none at all 
nor would 0.8— 1.0° C (about 2*^ F.) seem 
sufficient. The main point is to prevent the re- 
currance and the continuance of the high temp- 
erature. For this purpose one begins with a 
temperature of 15*^ C. (59° F.) for all baths be- 
tween noon and midnight. If this is not suffi- 
cient, all the 8 baths on the following day are 
given at 15°. In case the fever does not yield, 
the duration of the bath is extended to 18—20 
minutes. In extreme cases we advise the cold 
pack of 1, 2 or 3 quarter hours duration, to be 
changed every 10 minutes, to proceed the bath. 
We have thus succeeded in obtaining a reduction 
of temperature, which it was impossible to ob- 
tain by cold and prolonged baths. 

At times the resistance against the reduc- 
tion of temperature assumes a peculiar form. 
The reductions are sufficient and even great , but 
the temperature rises at once after the bath, a 
peculiarity more apt to occur in a late stage of 
the disease. In case we suspect this condition, 
we take the temperature every J hour between 
the baths, which may reveal that the temperature 
has reached its former height 1 — » 2 hours after 
each bath. This furnishes the indication to re- 
peat the baths every 2 or hours, so that the 
patient may receive 12 — 14 baths in 24 hours. 



166 — 



After 2 — 3 days of such an energetic but neces- 
sary battle the fever-curve no longer retains 
the ascending direction, the danger of an excess- 
ive hyperpyrexia has disappeared, so that 
less vigorous procedures and even the general 
formula may be employed. If typhoid fever- 
cases succumb, in spite of an early (from the 
4th or 5th day on) application of the method, 
we cannot help to suspect that the battle with 
the fever has not been conducted from the be- 
ginning with the necessary severity. These 
very cold and very prolonged baths, these pro- 
longed cold packs are, it is true, very unpleas- 
ant, but are born better than one would at first 
be inclined to believe. The hicrher the fever 
and the more resistance it offers the less 
is the danger of excessive refrigeration. 
Furthermore the period of the battle with the 
fever — if correctly conducted — rarely lasts 
longer than 3 — 5 days. 

In certain grave cases the period of relative 
apyrexia may be of very long duration. The 
curve will describe an undulation of 4 — 6 — 8 
days duration , so that one may be inclined to 
look upon them as a series of infections or relap- 
ses. Buch patients require a great number of 
baths (140 — 200). Is is however of special im- 
portance, that they be kept within the bounds of 
relative apyrexia, in as much as the fevercycle 



— 167 — 



is a long oiie having the dangers of hyperpyrexia 
in its wake. One cannot be too accurate in 
strictly carrying out the method, especially in 
the first part of this period i. e. in the first 10— 
15 days of relative apyrexia, because then an 
irregular and insufficient treatment may be fol- 
lowed by serious consequences. Equally good 
must be the nutrition of the patient. ''Feed and 
cool off'' — this precept is particularly valid for 
these tedious and grave cases. One must try to 
undo the harm, which each day of febrile con- 
sumption brings about. The allowance of wine 
may be increased to 800 grms. (about 1^ pint) 
after each bath, night and day, the patient must 
take nourishment of the quality fitting the stage 
<)f the. fever. Thanks to the happy eff'ect of the 
bath on the digestive functions, it is possible to 

. nourish the patient and notwithstanding the 
long duration of the fever, the patient will re- 
convalesce as certainly and rapidly as in less 
grave forms. 

At the time of the decline of the fever the 
baths should not always be omitted even, if the 
fever does not reach 39° C. (102.2° F.j any 
further. In case the condition of the patient is 
not a good one and nervous disturbances (e. g. 
in cases that come under the bath-treatment late) 
are present it is well to continue the baths at 

.88.5° (101.7° v.). These may be of shorter 



— 168 — 



duration than in the beginning. We have seen 
already that at the time of defervescence short 
baths produce the same reduction as long ones 
[at an earlier period.] 

Mild forms. The general formula is here al- 
ways sufficient. A mild case cannot be recog- 
nized as such in the first days. The first baths 
produce a more or less rapid but persistent move- 
ment towards defervescence. 

On the second or even first day baths can 
be omitted. As in the cases of medium gravity 
the period of the decline of the fever is a delicate 
one ; the baths must not be omitted too early. 
Just in such forms recrudescences and relapses 
are want to take place. They can be avoided if 
baths are given even if the temperature does not 
exceed 38. 5"^. 

Afebrile and hypo -thermic forms. The hypo- 
thermic forms in overworked and run-down 
individuals are apt to take on an adynamic form. 
Even in connection with low temperatures the 
function of the brain may be seriously disturbed; 
all the complications of typhoid fever can be 
observed in such cases, especially lung-compli- 
cations. These cases are grave, their mortality 
high. It is unnecesary to remark that the first 
indication is, not to use of antipyretic measures, 
but to overcome the initial complieaiion, the 
general prostration. It is neccesary to furnish 



to the body in some way the power to produce 
fever. For this purpose neither the formula 
of Brand, nor the cold bath of Jiirgensen, nor 
the lukewarm bath of Ziemssen is adopted, but 
alone the half -bath of 27° (80 F.) of 3—5 
minutes duration, with afPusions of 20—12°, 
(68—54 F.), gradually diminished combined 
with thorough rubbing. Such a bath repeated 

4— 6 times a day, together with compresses, 
good nourishment, strong wine and fresh air will 
meet the indications. Strube also, who in the 
afebrile typhoid has operated with various hy- 
driatic procedures praises the efScacy of the half 
bath. Mter a few days merely of this treatment 
fever makes its appearance, ^^so that the abnor- 
mal is connected into a normal form of the 
disease, with the prognosis peculiar to the 
same." (Brand) According to the indications 
furnished by the high degree of adynamia on the 
one hand and the intensity of the fever on the 
other hand either the half -bath with affusions or 
the general formula of Brand is employed. 

The tyyhoid fever of children. ''As a gene- 
ral rule one may, in the case of children begin 
with the general formula. The duration of 
the baths however is to be shorter ; a bath of 

5- 8 minutes duration is sufficient in the majority 
of cases. If a prolongation beyond 10 minutes 
if avoided, there are no accidents to be feared, 



The resistance of the fever is not so great in 
children. The chill makes its appearence earlier. 
It is rarely neccesary to carry on the battle 
with the fever very energetically and for any 
longer period. The child will cry, scream and 
resist and force has to he used to keep it in the 
bath . 

One may try to deceive it by using at first 
lukewarm baths, and further on cooler and cooler 
ones.'' 

Brand says on the treatment of children: 
"I add the practical hint, that children prefer 
even more than grown persons the colder and 
short bath to the warmer and long one and that 
they bear well even a bath of 12-15° C. (54-59° 
F.). It is therefore not acting according to their 
wish if high temperatures are chosen. An 
altogether bad practice however it is, (which I 
am sorry to say, is often followed) to use baths 
of a higher temperature and shorter duration. In 
such baths also the children are refratory and in 
as much as the baths are useless, the little ones 
are tormented without beeing benefited. The 
child must be kept a. ^ f rep from fever a-^ the grown 
person.' ' 

The fiiphoid fever of old people. ''Brand 
does not look upon advanced age as a contrain- 
dication. He is of the opinion, that up to 50 
yearii the general formula, as a rule, may be ad- 



-~ 171 



hered to. Beyond this period the Ziemssen bath 
is to be prefered. BrancVs results are very 
good ; out of 11 persons of this class thus treated 
all recovered. (8 between 40 and 50, 1 between 
50 and 80, 2 between 60 and 70). (T. &B.) 

Pregnancy and menstruation, Brand says, 
are no contra-indications to the hydriatic treat- 
ment. 

' ' Obesity which for medicinal treatment is 
a dangerous complication, is not so for hydriatic 
treatment. I have carried through a severe 
attack of typhoid fever a Hebrew woman weigh- 
ing 100 kgr. (about 200 lb.) and an excellent 
colleague weighing 120 kgr. (about 240 lb.) 
without any difficulty. The anasarca which is 
apt to develop in fat people is of no consequence 
and disappears itself in the period of convale- 
scence." (Brand.) 

'^Organic heart decease. For medicinal treat- 
ment this complication is considered particularly 
unfortunate. Of 6 cases treated with medicines 
3 died (in Basle) while of 8 treated with water 
all recovered." Brand. 

Siveating. Excessive sweating in tlie tirst 
week of the illness is a symptom making the 
prognosis unfavorable. It is however no impe- 
diment to bathing. The sweating which occurs 
later and which is of a critical nature is of a 
.diiffierent nature and significance and a sign "that 



— 172 — 



the stringency of the treatment may be relaxed 
during its presence bath may be omitted. 

The treatment of complications and of 

CASES that came UNDER TREATMENT LATE, 
AFTER TrIPIER AND BOUVERET. 

'^^ Typhoid fever cases that come under treat- 
ment in a late stage of the disease. It is to be 
regretted that cases of typhoid fever, in which 
the pathological process can be combated from 
the beginning, are not in the majority. Especi- 
ally in hospitals the cases are admitted after 
the 8 — 12 day of the disease has passed, when 
they are but rarely free from complications. 
They are then, to use a phrase of Brand, de- 
generated, and grave affections of the brain, 
the thoracic or abdominal organs are usually 
present. We shall later on discuss the means 
of treating these complications more fully ; it is 
however necessary to give a few general rules 
for the treatment of typhoid fever in a later 
period. 

What has to be taken into account in the 
first place is the condition of the patient's 
strength and particularly of the power of the 
heart. If the 15. or even the 20. day has 
passed, and the pulse is neither feeble nor 
frequent the ordinary formula can safely be em- 
ployed. We have obtained good results in these 



— 173 — 



on the whole unfavorable cases. What has to 
be avoided are loug baths ; cooler baths 22 — 18° 
C- (72 — 65 F.) of only 5 — 8 niinutes duration 
are to be prefered, which however must be re- 
peated, if the fever demands it every 2 hours 
or even every 1|- hours. More important, under 
the present circumstances, than any where else, 
it is, to individualize with the water treatment 
and to direct the treatment in accordance to the 
results obtained by the first baths. 

In case of pronounced heart -weakness with 
feeble and frequent pulse and the signs of hypos- 
tatic congestion of the lungs, the shock of the 
cold water is to be avoided, which the heart, 
enfeebled by the long continued fever, does not 
bear well, and in place of the cold bath, the 
luke-warm or gradually cooled-down bath to be 
substituted, and at the same time, and with the 
aid of alcohol, wine, champagne, and a suitable 
diet, the adynamia is to be combated, which in» 
creasing from day to day is the principle danger 
for these neglected cases. In case that the luke- 
warm baths for any reason cannot be given, 
ablutions are to be used which may be of a good 
deal of benefit. Cold enemata however are to 
be avoided. On account of deep and exclusive 
ulcerations of the intestines, which generally are 
present in such cases, that have been allowed to 
take their natural course, the cold enemata whose 



174 ^ 



usefulness is problematical, may be danger- 
ous byproducing repeated contractions of the 
intestines. 

Take it all in all the use of the baths must 
not be discarded. The hydriatic treatment is 
still better than anything else that could be 
advised, but requires niore care more attention, 
more patience, more supervision than in the be- 
ginning of the sickness. In the beginning of 
the sickness the patient might bathe himself, 
without any physician to advise him, and any 
nurse to watch him ; for which we have proof, 
having seen it done during an epidemic in a 
village. But in an advanced stage the use of 
the hydriatic method is something surrounded 
with difficulties and requiring tact and judgment. 
Yet even so it is a powerful weapon which in 
skilful hands may bring about unhoped for re- 
sults. 

In the Lyon Medical-Nos. 16, 17, 18, (1891) 
Bouveret has published an article iu which he re- 
ports on 100 cases of typhoid fever treated in 
the Hotel Dieu in the course of two years, accor- 
ding to BrancVs method. The mortality was 8 
per cent. It will be recalled that the results ob- 
tained by him in the Hospital de la Croix 
Rousse were 7. 3 per cent, and it was prophesied 
that in the Hospital Dieu his percentage of re- 
coveries would not be so favorable, the hygienic- 



— 175 — 



condition of the Hopital de la Croix Rousse ac- 
counting for the favorable results obtained there. 
Instead of an increase in the rate of mortality, 
we find a decrease of over 50 per cent. Thes re- 
marks however only incidentally. I find in this ar- 
ticle some interesting paragraphs illustrating the 
foregoing remarks, and shall insert them here. 

'^A number of my typhoid fever cases, 
treated by baths, were in a very precarious con- 
dition at the time of their admission, so that 
they almost had the appearance of hopeless 
cases. Four young women admitted on the 10th 
— 15th day and all suffering from a severe form 
of the disease, presented very alarming signs of 
heart- weakness. The pulse of very feeble char- 
acter exceeded 150 per minute, and in two of the 
cases it remained between 160 and 170 for seve- 
ral days. The beats of the heart presented alter- 
natively the foetal rythm and the bruit de galop. 
The bronchial catarrh was intense and was al- 
ready accompanied by hypostatic congestion of 
the lungs. I fear this weak condition of the 
heart far more than delirium and the symptoms 
of cerebral excitement in the first days of the 
invasion. 

Without doubt the acceleration of the pulse 
is a grave prognostic symptom. Neverless, I 
believe, I can support the statement, that in 
young persons and particularly in young women 



— 176 — 



neither the foetal rythm, nor a rate of 160 — 170 
are, as has been said, certain signs of a fatal 
termination. These four cases of typhoid fever 
were bathed and recovered, although they pre- 
sented for several days these two signs of heart- 
weakness. 

I am in the habit of paying particular at- 
tention to the treatment of such cases. If a case 
of typhoid fever of such a grave character ar- 
rives in an advanced stage of the disease, I 
begin with lukewarm baths, 26° — 28° and 
even 30° (79, 83, 86 F.) and determine the 
temperature and the duration of the follow- 
ing baths by the resistance which the organ- 
ism offers to the refrigeration. If these luke- 
warm baths produce an abatement of the tem- 
perature of one degree C. (2 F.) I have them 
continued. If the reduction of the temperature 
is very feeble or even replaced — which is very 
rare in this class of cases — by an elevation of 
temperature after the baths, I lower the tem- 
perature of the Abater to 26°, 24°, 22° and even 
20° (79, 75, 81, 68 F.) This is the way in which 
I proceeded with my four patients. One of them 
continued to take baths of 26°— 28° (79— 83F.) 
which were sufficient to combat the fever effi- 
ciently, this being reduced on the 12th or 13th 
day of treatment. The other three took baths 
of 20° (68 F.). I have observed neither faint- 



^ 177 ^ 

ing spells nor attacks of syncope in the bath and 
I attribute the result to this rule of my practice: 
in the grave cases with signs of heart- weakness 
not to administer at once the real cold baths, to 
explore with the luke-warm or moderately cool 
bath the power of the patient to resist the sys- 
tematic process of refrigeration. 

The immersion is only a part of the treat- 
ment. I have each bath preceeded by a thor- 
ough friction of the whole body, (excepting the 
abdomen) energetic enough to produce a lively 
rubef action of the skin. These repeated excita- 
tions always seemed to me to act favorably on 
the heat regulation during the duration of a cool 
bath. I have them take in 24 hours 2 J to 3 
litres (2|^— 3 qts nearly) of milk, one bottle of 
old wine, 50- — 100 grms. (2—3 ounces, nearly) 
of rum and in some very grave cases I have ad- 
ded champagne and infusion of coffee. And I 
assure myself repeatedly that my directions are 
carefully carried out. These cases are under my 
own direction where I have a corps of nurses so 
excellent, so zealous, so well posted in the method 
of the cool-bath-treatment that it gives me 
pleasure to acknowledge this. 

The heart of these grave typhoid-fever-cases 
remains very excitable into an advanced period 
of convalescence. On the tenth day of defer- 
vescence the pulse of my four cases was 120 

12 



— 178 ~ 



eveu when restiDg, and upon any excitement it 
went up to 140 and beyond that. It is neces> 
sary to prescribe to these reconvalescents com- 
plete rest of the body and mind, in bed. until 
their strength has sufficiently recoyered and their 
heart no more presents this dangerous excitea- 
bility. It is the best means to ayoid a fatal 
syncope.'* So far from the Lyon Medical. 

Let us take a graye case, haying reached 
the end of the second week, with continuous de- 
lirium, a temperature of oyer 40.5^. hypostatic 
congestions of both lungs impending, with abun- 
dant diarrhoea and some signs of heart weakness. 
The patient has been treatad with many more or 
less efficient remedies. The delirium had re- 
quired musk, bromide of potassium or camphor; 
the feyer some antipyretic remedies, quinine, 
antipyrine, antifebrine ; the congestion in the 
lungs at least kermes or ipecac ; the diarrhoea 
bismuth ; the heart-weakness digitalis etc. 
What a superiority has not the water treatment 
over all these medicines! It knows of but one 
remedy, cold water, and to meet the majority of 
the indications j^roperly, it is only necessarry to 
select from the numerous procedures at its com- 
mand, the one which seems the best adapted. 

Xervous sijmptoms, — The minor neryous 
symptoms Avhich we find in various degrees in 
all cases of typhoid fever, the headache, the 



_1?9 ~ 



sleeplessness, the languor, the tinnitus, the diz- 
ziness will be removed or ameliorated by the 
baths, whose number and degree wall be fixed by 
the height and general course of the fever. 

AVe intend to speak here about the more 
grave nervous affections, the delirium, the 
ataxia, the restlessness, the stupor and the 
coma. These depend perhaps more directly than 
the others on the hyperpyrexia, for they gener« 
ally are the first to disappear in cases that have 
been treated perfectly. The first indication then 
in their presence is to combat the fever and to 
modify the general formula in such a way as to 
produce as quickly as possible a reduction of the 
temperature. Brand recommends to pour very 
cold w^ater on the head and to continue the bath 
until the heat and the redness of the face have 
disappeared and to cover the head in the inter- 
vals with cold compresses to be changed re- 
peatedly or with an ice-bag. 

In the atactic forms with early delirium and 
great restlessness the indication is to reduce the 
generally very high temperature still more. The 
fever must be cambatted energetically with cold 
water; if the hyperpyrexia demands it one must 
not hesitate to use baths of Id"" (59 F.) of 15—20 
minutes duration for one need not fear in these con- 
ditions to see as has been said, that under the in- 
fluence of the coolino- process the excitation will 



„ 180 — 



be followed by a stage of de pression . The pa- 
tient , who often is under the influence of a f ii- ' 
rious delirium has to be kept down in the bath 
by main force, long enough, in spite his restless- 
nes^s to obtain the average reduction of 0.8 — 1.0°. 
The patient must further be protected against - 
bumping himself too frequently against the sides 
of the tub. A delirious case of unusual severity 
was covered towards the end of the the treat- 
ment, over his whole body with contusions. 

which changed into small abscesses The 

combat against this furious delirium may last for 
days. In the case mentioned, the delirium did 
not disappear before the third day of treat- 
ment. The patient being unconscious one is not 
obliged to take his sensations in account. A pa- 
tient of Glenard was not conscious of being 
treated with cold baths until he had his 32. 
one. He recovered. 

In case that the ataxia is complicated by 
convulsions every irritation of the nervous sys- 
tem ought to be avoided. The conditions are 
difLcrent from those of epilepsy. Brand ad- 
vises to discontinue the process in the presence 
of the convulsive attack, to combat the excessive 
heat by ablutions and cold compresses, but to go 
back to the baths in the intervals. One must 
keep in mind that it is not the stimulating but 
the antipyretic effect of the water which here is 



— 181 



desired and hence the luke-warm full bath with 
affusions is to be preferred to the cold full bath. 

In case that delirium and ataxia have exis- 
ted a long time or have appeared in a later stage 
of the disease matters are different (italics by S.) 
and it is generally advisable not to proceed with 
the same severity as in the early delirium* 
Brajid recommends baths of 22—25^ (72™77F0 
but of longer duration 15—20 minutes together 
with a slow and moderate affusion of the head 
to avoid the sudden impression of the cold water. 
In case an adynamic condition is accompanied 
by delirium 3 or a frequent and small pulse 
indicates heart* weakness, the luke»warm, or the 
gradually cooled down batV is to be recommen- 
ded. 

In case deep stupor is the prominent symp- 
tom, the treatment has to be antipyretic and 
stimulating. Brand mentions that in such cases 
Jiirgensen's method maybe of good effect: full 
baths of 10—20°, (50— 68F.) 5—10 minutes du» 
ration, but prefers the half bath of 25^ (77 F.) 
with short but very cold affusions accompanied 
by thorough rubbing. The method of Jiirgen- 
sen can only be employed in hospitals o The 
half bath with cold affusions seems preferable to 
us, because it can be used also in the later stages 
of the disease. In case the patient is in a pro- 
nounced comatose condition the condition is 



182 — 



far more dangerous. The paralytic condition 
of the brain is generally accompanied by a weak 
condition of the heart. The patient is not in- 
fluenced by any stimulating agencies, the pupils 
are wide, little influenced by light and the pulse 
is weak, over 150—160 per rain.; collapse is im- 
pending. We have seen in such cases baths 
according to the formula being followed by con- 
siderable and dangerous reductions. In such 
cases one must act with the view to stimulate 
and cool ofE at the same time. A very short 
cold bath, or a short affusion, a lukewarm 
half-bath with cold pack and frictions of the 
w^hole body, with exception of the abdomen are 
here to be prefered. Winternitz who is of the 
opinion that the hyperpyrexia and the retention 
of the fever-heat is at the bottom of the grave 
symptoms highly recommends these energetic 
and prolonged stimulating procedures to the 
skin. In many such grave cases one is success- 
ful in removing the coma ; the patient regains 
consciousness ; unhappily however the heart- 
weakness persists, leading to broncho. pneumonic 
complications to which the patient succumbs. 

Thoracic symptoms and complications. In 
case the initial bronchitis is of a high degree the 
ordinary formula can be employed at once. It is 
not nocessary to diminish the shock of the cold 
water. The sudden impression of the low tern- 



perature produces cough and expectorations, 
stimulates the circulation in the lungs and 
prevents the formation of hypostatic processes. 
Brand mentions the method of von Gietl in 
Munich, who for years has employed cold 
affusions in the lukewarm half bath against this 
intense bronchial catarrh of typhoid fever. 
Besides this he recommends, to relieve the pain, 
cold compresses to the chest repeatedly to be 
changed. Patients however do not bear well 
this continued application of cold to the chest. 
The baths always have seemed sufficient to us 
to bring about improvement of the initial 
bronchial catarrh. 

Cough at times is very violent and accomp» 
anied by thoracic pains. The former grows less 
as soon as the temperature begins to sink. 
Should that not be the case a mixture of alcohol 
and opium to be taken before or after the bath 
can be recommended. 

One not accustomed to the method who sees 
a severe bronchitis develop in the first days of 
the treatment, and to persist, is very apt to 
diminish the number of the baths, and to in- 
crease their temperature or to discontinue them 
altogether. This is a mistake which must be 
avoided for in the grave cases the cessation of 
the bathing is followed at once by a rise of the 
temperature to the former height together with 



~ 184 — 



a reappearance of the grave symptoms and an 
aggravation of the bronchial catarrh. The latter 
often is followed later on by hypostatic pneu- 
monia and broncho - pneumonia. Medicines 
(Ipecac) ordinarily useful in such conditions 
are here without avail, and have besides the 
drawback to increase the tendency to adynamia. 
The treatment must be continued fearlessly and 
systematically; experience will demonstrate in a 
few days, that the bronchitis will diminish in in- 
tensity. 

As far as the hypostatic and bronchopneu- 
monic process of a later period of the disease are 
concerned the best means to prevent them is an 
early and vigorous application of the method 
especially when an itial bronchial catarrh of any 
degree of intensity should be present. As a 
rule however these complications, we are sorry 
to say, are fully developed. In case that the 
pulse is not frequent and especially if we have 
not to do with a case that comes under treatment 
in a late stage the ordinary formula can be em- 
ployed. We have of ten seen hypostatic congest* 
ion disappear after a number of baths have been 
given. — In case however the heart has become 
enfeebled (high puls-rate) if we have to do with 
a case that has not been bathed in the first period 
of the disease, we prefer to use the luke-warm 
or the Ziemssen bath and extend its duration. 



— . 185 



The treatment must however be carried out re- 
gularly a bath when the temperature reaches 89° 
(102.2 F.) the temperature to be taken every 3 
hours. — AVine and alcholic liquors are indica= 
ted to sustain the flagging heart-energy and to 
combat the tendency to adynamia which almost 
always is present in these complicated cases of 

typhoid fever 

The initial lobar peumonia does not demand 
a modification of the treatment j but rather 
demands it two-fold. The elevation of tempera- 
ture is the chief point of attack for the treat- 
ment. The ordinary formula can be used and in 
case the fever is very high baths of a lower tem* 
perature and in more rapid succession can be ad- 
ministered, just as if we had to do merely with 
a grave case, not complicated by an intercurrent 
pneumonia (see the treatment of the grave 
forms). — In case that the pneumonia appears 
in the course of fever, the cold baths still give 
good results (See Chapter IV, case V.) and theex- 
cessive hyperpyrexia, always foreboding danger^ 
always requires, as long as heartweakness is not 
pronounced an antipyretic process which can 
only be brought about by means of the cold 
baths of by a prolonged cold pack. To meet 
thus the indication of reducing the hyperpyrexia, 
and at the same time taking account of the 
eeble heart, the lukewarm or gradually cooled 



186 



down bath with cold aifiisions to the head is 
to be preferred. 

With some j)atients pain in the chest makes 
the baths very unpleasant. We have seen that 
in one case complicated by a lobar pneumonia 
the excessive pleuritic pains made the abandon- 
ing of the baths necessary. In such cases Brand 
insists on ihe application of cold compresses to 
the chest for the purpose of removing the 
thoracic pain and the pleuritic stitch. We do 
not make use of them, because they are uncom- 
fortable to the patient and a source of incon- 
venience. If the pains continue, we prefer a 
hypodermic injection of morphine. In general 
we do not employ these much in typhoid fever, 
having seen the jDunctures form the starting 
points of abscesses. 

Disturbances of the circulation. During the 
whole course of the fever the careful auscultation 
of the heart ought not to be neglected, inas- 
much as the treatment and the prognosis de- 
pends a good deal on the condition of this or- 
gan. 

Some patients have a great tendency to 
fainting spells either in the bath or in the inter- 
vals between the baths. These frequently are 
of a transient character disappearing at the same 
time that the patient accustoms himself to the 
cold water and th^t the latter exerts its beneficial 



^ 187 



influence on the fever* The simplest remedy 
against this unpleasant symptom is to administer 
a liberal dose of alcohol ^ rum, brandy in sugar- 
water, old wine, chamjjagne, or a mixture of 
alcohol and opium mentioned above. It is use- 
ful to sprinkle head and chest of the patient 
with very cold water to mitigate the shock which 
the patient experiences on being immersed in 
the bath. If these means are of no avail and if 
the syncope returns with each bath it may be 
necessary to replace for a time or definitely the 
cold bath by luke-warm or gradually cooled down 
baths. 

In case of collapse Brand recommends not 
to discontinue the baths. To proceed w^ith the 
baths is according to him, the best means to pre- 
vent its return. In case the shock of the cold 
water is not well born, the gradually cooled 
down bath can be made use of to combat the 
fever. In case that collapse appears during re- 
convalescence it must be treated with diffusible 
stimulants, warm drinks and alcohol. This is 
the practice of Brand, 

The shock of the cold water setting in sud- 
denly in the stage of fever may itself be of some 
use. The short cold bath, the cold affusions, the 
luke-warm half bath with cold afiusions com- 
bined with rubbing of the skin and massage of 
the extremities, these are the proceedures appli- 



— 188 ~ 



cable in such conditions. As a rule the collapse 
is only transient, the fever returns and the ordi- 
nary line of treatment can again be taken up. 
To prevent its return, the dose of wine or alco- 
hol must be increased. In the interval between 
the baths we order the chest and the limbs 
thoroughly to be rubbed two to three times, 
four to five minutes with a piece of flannel satu- 
rated with eau de cologne or essence of turpen- 
tine. The same procedure we advise in cases 
where a very frequent and small pulse indicates 
a feeble condition of the heart. The last resort 
are subcutaneous injections of ether. According 
to the condition every one to two hours or more 
frequently a Pravaz' syringe full of ether is in- 
jected, preferably into the upper extremities. 
These injections, however, have the drawback, 
that at times they produce extensive abscesses, 
a drawback, which cannot be taken account of 
considering the far greater danger from the eoh 
lapse. 

It may hajDpen that in spite of all these meas- 
ures the collapse continues. The only thing that 
is left to revive the deficient activity of the heart, 
is to envelop the whole body with the exception 
of the head into flannel (blanket) saturated with 
hot water, and to thoroughly apply friction to 
limbs and chest, omitting the abdomen, the cloth 
of course remaining between hands and the body 



— 189 — 



surface. This process is to be repeated every 10 
minutes. While the patient is thus rubbed and 
his body heat restored, he repeatedly takes some 
strong wine or hot punch. 

Syncope demands the same mode of treat- 
ment. If — -what rarely happens— it takes place 
during the bath, the patient is taken out of the 
bath and placed with the head as low as possible 
on a mattress or a bed and all the remedies 
suitable to bring back and stimulate the activity 
of the heart are to be employed. Such are 
whipping the face, blowing upon the cornea, 
titillation of the nostrils, faradization of the re- 
gion of the heart, energetic friction of the whole 
bodj^ etc. When the patient has regained con- 
sciousness he is warmed with hot drinks, hot 
cloths, and hot jugs of water. The same reme- 
dies can be used in cases of syncope occurring 
between the baths or during reconvalescense. 
Unhappily they of ten. are of no avail. 

Permanent weakness is a frequent and dan- 
gerous accompaniment of all cases of typhoid 
fever that come under treatment late in the dis- 
ease. The pulse is very frequent and very 
week, the face and the extremities are cyanotic, 
the peripheral temperature sinks lower and 
lower, while the central remains high. One 
need not at once discard the use of the water in 
such cases; often the abstraction of heat alooe 



190 »~ 



makes these bad symptoms disaj^pear in the 
course of a few days. If the contiary takes 
place, if the symptoms grow worse after the first 
baths, the liike-warm or gradual cooled down 
bath finds its proper place. It is however neces- 
sary to bathe regularly. Often if the central 
temperature is very high, it is useful to give the 
baths close together, every two hours. The pa= 
tient must have day for day large doses of alco- 
hol. Digitalis we consider useless and even 
dangerous. Between the baths v>e often apply 
the packing and rubbing as described under the 
head of collapse. 

Intestinal hemorrhage. We have in a pre- 
vious chapter distinguished between two kinds 
of hemorrhages: an early, false, and a late^ true,, 
hemorrhage. 

The early hemorrhage does not require the 
cessation of the baths. These even may exert a 
favorable influence on the hyperamia of the in- 
testinal mucous membrane, which in all proba- 
bility is at the bottom of these early hemor- 
rhages. In a case of Eayna ucVs the loss of blood 
was controlled by a bath, after all other rem- 
edies had proved inefPectual. Undoubtedly this 
was a case of congestive hemorrhage. The local 
application of cold to the abdomen is very useful 
while medicines are without effect. 



^ 191 



The late liemorrhage demauds a temporary 
and often a permanent discontinuation of the 
baths, but not only of the baths, but also of the 
enemeta, because the energetic injection of the 
cold water into the colon excites also contrac- 
tions of the small intestines and interferes thus 
with the arrest of the hemorrhage. For the same 
reason abstension from eating and drinking, as 
far as possible, is indicated. The intense thirst 
which is apt to accompany the profuse hemor-^ 
rhage must be quenched with small pieces of 
ice. Only very small quantities of milk or broth 
cooled with ice are to be permitted. The exter» 
nal application of cold can best be accomplished 
by a large icebag to the abdomen fastened to a 
hoop fixed on to the bed-stead preventing the 
same from slipping. Ergotin in a mixture or 
per injection has been recommended. But this 
remedy has not seemed very efficacious to us. 
That injections easily lead to the formation of 
abscesses has been mentioned. The styptic rem- 
edies, tannin, plumb, acet., liq. ferri sesquichlor. 
have a very doubtful effect ; it is better not to 
employ them. Opium in large doses is reserved 
for peritonitis and intestinal perforation. 

In case that the hemorrhage is of a dan- 
gerous character from the beginning, there re- 
mains as a last resort the transfusion of blood. 
This was performed with success in such a case 



— 192 — 



by Gibert in Havre. His patient had lost 1500 
grms. of blood at one time so that death seemed 
imminent. Gibert made two injections on two 
consecutive days, 30 grms. the first and 60 
grms. the second day. The patient recovered. 
In case blood is not at hand, nor a transfusion 
apparatus intravenous saline injections must be 
sufficient with a simple and readily prepared ap- 
paratus of the form of a syphon, this small 
operation can readily be executed (L. Bouveret, 
Intravenous saline injections in the treatment of 
cholera) Schwarz has advised a saline solution 
simple and everywhere preparable. 

Water 1000,0 

Salt 5,0 

Soda a few centigramm. 

This solution has repeatedly been used with 
success in cases of anaemia produced by profuse 
hemorrhages. This seems to show that this or a 
similar fluid is able to take the place of the 
transfusion of blood. 

In case the threatening danger has jjassed by, 
the hemorrhage has ceased, the collapse been re- 
covered from, the strength of the patient must 
carefully be built u]^, so that the former line of 
treatment may be taken up again. The hemor- 
rhage is followed by a constipation lasting seve- 
ral days. Not before three to four days anything 



should be done against this condition with cold- 
^vater-eneniata. 

In case that the hemorrhage was not very 
.severe, and the patient was near the time of 
defervescence, and in the absence of any dan- 
gerous symptoms the cold baths can be ommitted; 
cold compresses or ice-bags to the abdomen are 
sufficient. Experience teaches that as a rule 
such patients make a rapid recovery. 

Matters are different if the hemorrage when 
profuse takes place in an adynamic case who 
has come under the bath treatment late. 
The hemorrhage here generally proves fatal. In 
case the fever continues high an attempt can be 
made to go back to the baths, after the hemorrh- 
age has ceased for several days. There are 
cases on record where this line of treatment was 
successful. It is however impossible to be 
certain, whether the bleeding has ceased defi- 
nitely, and on the other hand every further loss 
of blood, considering the low condition of the 
patient, must be avoided. Even in the cases of 
extreme adynamia we prefer to keep the patient 
in bed, apply ice to the abdomen and give some 
doses of quinine, after the method of Jjiebermeis- 
ter. The building up of the patients strength, 
with the aid of wine and the proper kind of food 
is obvious. 

13 



l^ERFOKATtOX OF THE INTE8TIXES. PERILOINTl?^. 

The differential diagnosis between these 
two complications is difficult , a circumstance of 
little importance as far as treatment is concerned 
this being identical and requiring almost the 
same remedies as the intestinal hemorrhage. 
The baths are to be discontinued at once, the 
abdomen is to be covered permanently with ice- 
bags, and this is to be continued until the peri- 
toneal pains have disappeared for several days. 

The secondary peritonitis produces less 
severe symjDtoms than the primary, and the 
inflammation of the peritoneum can proceed in 
installments in the course of typhoid fever. 
This fact has to be kept in mind so as not to let 
up too early with the local application of cold. 
Every intestinal movement is even more to be 
avoided than during the hemorrhage Food and 
drink must be quite cold and administered in 
small quantities at least as long as there are 
present dangerous symptoms. Enemata are 
harmful even if constipation is present. The 
remedy to keep the int(!stinal tract immovable 
is opium in large doses. We prefer the liquid 
preparations and give 0,1—0,3 grm. (1^ — 3 
grains) in a mixture, or 2, 3 to 4 grms (15, 30 
to 45 minims) of tincture of opium. Still better 
are morphine injections, 0,02—0,05 grms (one- 
third to five-sixths grs.) per day. These strong 



doses are less dangerous than one might imagine; 
the intensity of the pain is the guide for the 
tolerance of the organism. The patient must be 
kept in a condition of narcosis which is less 

dangerous than the jDeritonitis As 

in the case of intestinal hemorrhage the fever is 
to be combatted by the local application of cold 
and quinine, careful diet and absolute rest to be 
enforced, and the constipation produced by the 
opium to be let alone for a long time. Of 
course if cases are treated systematically, and 
from the beginning with water, these complica- 
tions will only occur exceptionally, for — we 
repeat— this method if used in time will keep 
wdthin bounds the intestinal changes peculiar to 
typhoid fever, which are the cause of the per- 
foration and peritonitis. 

(The following paragraphs have been 
omitted : Disturbances of the digestion . Diar- 
rhoea and meteorism. Constipation.— Severe 
ehill after the bath.— Abscesses. Furunscles, 
Decubitus.— S.) 

THE TREATMENT Of^ THE DEGENERATED ' ' (COM- 
PLICATED, CRITICAL, neglected) CASES 
ACCORDING TO BRAND. 

According to the definition of degenerated 
typhoid fever, cases of this character present a 
variety of clinical pictures, theis prognosis i« 



doubtful, aucl the indication? which are to be 
satisfied in their treatment are difficult to fulfill. 

This is pai*ticularly the case if the Water- 
treatment is requested as a last resort for dying 
patients. For now the lack of time is added to 
all the other difficulties— the patient dies before 
the method has time to unfold its powers. 

While in Germany, where the profession 
has become more and more convinced that the 
beginning of the disease and not the end is the 
proper time for the hydriatic treatment, such 
cases have become rarer, they must necessarily 
be met with more frequently there where the 
cool-bath-treatment has not yet become popular. 
Hence a short direction for the management of 
such critical, neglected and complicated cases 
may be of interest. 

The consideration and decision whether 
such a desperate case is to be subjected to hydri- 
atic treatment must rest not so much on the gen- 
eral condition of the patient but on the intensity 
and extensity of the local pathological changes. 

The general condition, generally dependent 
on the fever, is apt to improve- — providing the 
time is not too short— almost in every case under 
the use of water 

But hopes kindled fresh are often treacher- 
ous. In spite of the general improvement death 
ensues in consequence of local conditions. 



— 197 ~ 



The indications in the degenerated cases of 
typhoid fever are not as simple as in the normal 
cases. The fever is not the main factor with 
which we have to deal, but there exist a num- 
ber of special conditions that have to be taken 
into account. 

If such a case of degenerated typhoid fever 
comes under treatment, the chief concern often 
is to remove the most pressing dangers to life, to 
resuscitate the poiver of resistance of the organism 
which has almost vanished, before one can think of 
treating the disease j^Tojyer. 

On the whole the indications are (1) to sub- 
due the fever which is still present, (2) to 
relieve the various local disturbances and com- 
plications. 

To get control of the fever is as a rule not a 
difficult task. But the kind, form, and mode of 
application of the water must be regulated by 
the condition of the brain and nervous system , 
and their organs are generally in a bad way. 
They are in a condition approaching paralysis 
more nearly, than a state which will allow^ a 
normal function and activity, and a stimulating 
proceedure may bring about the latter condition , 
but may, if carried to excess be the cause of the 
former, so that the difficult problem is met, of 
applying just the proper degree of stimulation. 
Great energy is plainly not in place in the treMt^ 



— 198 



ment of degenerated typhoid fever. The water- 
treatment demands the greatest energy in the 
heginning of the sickness and the greatest delicacy 
and caution in the hours of danger during the 
later periods of the disease. 

It is a great error to suppose that under the 
critical conditions, which will be described, any- 
thing can be accomplished by force in the appli- 
cation of hydriatic proceednres 

Keeping this in mind there is but one pro- 
ceedure in place in the beginning of a treatment 
of a case of this form, yiz: the gradually cooled 
down full bath with affusions of decreasing tejn- 
perature. This is repeated according to the con- 
dition of the patient but not oftener than every 
three hours, to bring about, with guarded haste 
a condition of apyrexcia. In case of improv- 
ment the tact of the physician must decide when 
and if the cool full bath is to take the place of 
the gradually cooled bath. 

In case however that it is not possible to 
remove in reasonably short time the brain symp- 
toms the patient, after his hair is cut olf short, 
is to be placed into a half-bath reaching to his 
umbilicus, of a temperature of 82° C. (90° F.) 
the surface of his body rubbed vigorously and 
cooler and cooler water to be poured over him. 
First with the water of the bath, then with water 
of the temperature of 80, 70, 60, 55° F, 2—8 



— 199 — 



quartfi at a tiiue. The duration of the bath 
mast not exceed ten minutes. After the patient 
is brought back to bed, his feet are wrapped up in 
flannels, saturated with hot water, and well 
wrung out, and these compresses are to be renewed 
every 10 minutes for two hours. The baths are to 
be repeated not oftener than every two hours. 
In case the effect has passed away earlier than 
the time for the next bath has arrived, or if no 
effect has been produced by the same, cold water 
may be poured over the head without taking the 
patient out of his bed. It is also advisable to 
cover the head with ice-cold compresses. The 
necessity of the administration of strong wine in 
large quantities, or Stoke 's cognac mixture, 
(Cognac 2 ounces, yolk of one egg, cinnamon 
water 2 ounces, simple syrup 1 ounce. Table - 
spoonful every hour) is self-evident. 

As long as the patient continues to breath, 
these exertions must be kept up assiduously, 
niay the patients appearance be ever so hopeless. 
If there is a possibility of his recovery, this pro- 
cedure w^ill bring about the desired result. 
There are examples on record where sucli deter- 
mined efforts have been crowned with success. 

After the ])atient has regained consciousness 
one gradually and carefully under the use of the 
gradually cooled full-bath approaches the ordi- 
nary anti -febrile proceed ure which finds its 



— 200 — 



expression in the ordinary formula hoivever with 
this single restriction, that the baths in the treat- 
ment of the degenerated typhoid, have as a rule, 
to be shorter than in the treatment of the nor- 
mal typhoid — just long enough to create and 
keep up the necessary afebril condition. As a 
rule ten minutes ^vould seem sufficient, excep- 
ting in the atactic forms. 

The treatment of the local syjuptoms by 
the water can, unfortunately, not be as direct as 
is desirable. Happily this is not as necessary 
as under other treatment. 

If the fever has ceased and the elf ects of the 
afebrile condition had a chance to develop, such 
conditions as the normal activity of all the 
organs, excepting those which are the seat of pat- 
hological changes, further a good appetite and a 
sufficient nutrition with an increase of strength — 
such conditions cannot but be favorable to the 
diseased organs. For it is an undeniable fact 
that local disturbances get worse while the fever 
continues and improve as the fever disappears. 

Effects of the cold bath, which have not 
yet been mentioned, and which have not received 
the estimation they deserve, are those of stimu- 
lation and revidsion the latter of which can be 
increased by energetic nibbing. 

On the direct and indirect effect of cold to 
the living organism, physiology teaches the 



— 201 — 



following: (Subti:)ig Se§rbuc| ber ^P^pfiologie be§ 
SRenfd^en, 33b, I. S. 310. u, fO ^^Amongst the 
influences which are able to call forth the activ- 
ity of the irritable nerves, cold, (heat) and 
mechanical causes are the first to be mentioned. 
Free heat only excites in us the sensation of 
warmth or cold, if it is either increased or 
decreased in intensity and ceases to have any 
effect if it acts on the skin in a uniform degree. 
The strength of the sensation, (irritation) 
depends (a) on the rapidity with which the 
change in temperature takes place; (b) on the 
temperature of the skin; (c) on the extent of 
surface of the skin exposed at the same time to 
the change of temperature. The greater, further, 
the difference between the temperature of the 
skin and that of the agent acting on the same, 
the more lively will be the effect produced." 

Whether the half -bath with cold affusions, 
or the cold full bath is employed in the treat- 
ment of typhoid fever, in either case the change 
of temperature is a brusque one— the difference in 
the temperature of the skin and of the water used 
being considerable, about 26"^ 0. (47° F.) and 
at the same time the whole surface of the body 
is exposed to the sudden change of temperature, 
in short all the conditions necessary for a power- 
ful stimulation are given. The cold half -bath 
and full -bath are therefore capital stimulating 



— 202 — 



remedies. And why should that be denied? 
Does not daily observation in cases of syncope and 
and other similar conditions show the powerful 
reviving influence of cold water on the organ- 
ism? x\nd who ought not to know , that in 
typhoid fever consciousness can be regained and 
preserved by the use of the cold batli without 
producing an essential reduction of tempera- 
ture? 

Aside from the abstraction of heat and the 
stimulation, a third effect must be ascribed to 
the cold bath, w^iich is not so striking, but 
w^hich according to the observations of Winter- 
nitz is undeniable. That is the revulsive effect. 

After the influence of cold on the cutaneous 
surface of the whole body, (Winternitz, Wien. 
Medc. Wochenschrift 1868) the tonus in the 
contractile structures of the skin and the blood- 
vessels in particular, is diminished, the muscu- 
lar coat of the arteries relaxes and thus the 
blood vessels of the skin are considerably dilated 
and their capacity as a whole increased. The 
vascular channels will not be tensely fllled with 
])lood. Each systole of the heart throws a por- 
tion of blood into the arteries, which take it up 
with avidity, without becoming tense, because 
their volume being iucreased they can carry 
more blood than before. In the same way the 
relaxed veins can stow away more of the ])lood 



— 208 — 



which passes iDto them, on account of their 
increased capacity, in the same way as in the 
Klopf-versuch of Goltz. Just as the dilated 
mesenteric vessels, in the experience of G., so 
here the relaxed blood-vessels of the skin, acting 
like a sponge, absorb the blood from the inner 
vessels, relieve them of their contents and 
decrease the teiLsiou existing there. The effect 
of such a filliug of the blood-vessels of the skin 
will therefore be the cause of a lower blood- 
pressure in the internal organs, of a decrease of 
the amount of blood they contain, of a retard- 
ation of the flow of blood, and of the activity of 
the heart and other internal organs, a reduction 
of temperature and a quieted nervous system. 

The esential part however of this process 
depends mainly on a real derivation of blood to 
the shin. 

These general effects of the bath afe aided 
by compresses, which according to their temper- 
ature, size and more or less frequent renewals act 
antiphlogistically or stimulating; in the former 
way if they are changed continually or kept at 
the same temperature by means of ice, in the 
latter way, if they are allowed to become moder- 
ately warm, before they are changed, in which 
case there is produced with each change a slight 
degree of shock. In as much as in typhoid 
fever it is not so much a condition of inflammation, 



^204 — 



as a semi-paralytic condition of the intestines 
with which we have to deal, the latter form of 
applying the comjDresses is the more common one 
and a change every 15 — 30 minutes generally 
advisable. In a cool condition however the abdo- 
men and chest ought to be kept all the time. 

Summing up it can be said, that in the 
degenerated typhoid fever the hydriatic treat- 
ment (1) will bring about a condition of 
apyrexia, (2) will remove the semi-paralytic 
condition of the different organs, (3) relieve the 
diseased organs by revulsive action. 

All the forms of degenerated typhoid fever, 
which can be reached by the activity of the 
baths will be cured, the rest Avill not. 

To aid the activity of the baths, alcoholic 
stimulants are of importance. 

Murchison, after a rich experience, gives 
the following advice in the use of alcohol: 

"^In individual cases, the chief indication 
for the use of alcohol is derived from the state 
of pulse and heart. 

A soft compressible pulse, and still more an 
undulating, irregular or intermitting pulse, or 
even an abnormally slow pulse (40 to 60) are 
stronger indications, than more rapidity. If 
stimulants quicken the pulse, they are contm- 
indicated. 

2» Coldness of the extremeties is an indi- 



cation for alcohol, especially wheil at the same 
time the temperiatnre of the trunk is considerably 
elevated . 

8. The more the typhoid state (i. e^ 
stupor, low delirium, tremor, subsultus) is 
developed , the more will alcohol be demanded. 

4. The presence of complications^ as a rule 
' increases the necessity for stimulants. 

Port, sherry, brandy are the forms in which 
alcohol is best given, but when a weaker stimu- 
lus is wanted, claret answers well. Sherry and 
port contain from 17 to 24 per cent of alcohol, 
spirits from 50 to 60, Spirits ought to be given 
diluted in cold water or milk. But where there 
is great prostration and especially w^here the 
skin is cold and covered with prespiration, the 
the best stimulant is hot brandy— or whisky - 
punch, or wine-whey. 

Stimulants ought to be given in divided doses 
frequently repeated, In urgent cases, the dose 
may be repeated every hour and as a rule a 
larger dose will be required during the night 
and towards morning, that the vital powers are 
at the lowest ebb. 

It is very rarely necessary to give more 
than eight ounces of brandy at any period of the 
fever. 

As soon as the symptoms for which alcohol 
is given begin to recede, the quantity ought to 



- ^0^ - 

be reduced and Hnialler dose.* ordered at lotogel* 
intervals," 

These rules of Murehison are so excellent 
that they ought to be followed by everybody* 

Before each bath a liberal quantity of stim- 
ulaiit is given; after the same, warm milk, 
bouillon etc. After midnight the doses of wine or 
brandy ought to be larger than daring the day. 

After the symptoms diminish the quantity 
of spirits or of wine (Haut Sauterne, Chablis^ 
Monbrachet) is reduced, not however below half 
a bottle (of the wine.) 

In case of a collapse wine is not sufficient. 
It is better to give a tumbler of rum or cognac 
with hot water (half and half) and if necessary 
to force the patient to take it. 

As far as the diet in the degenerated 
typhoid is concerned, this ought to be as nourish- 
ing as the condition of the patient will permit. 
The chief article of diet is here also milk, either 
pure or mixed with coffee or tea, and broth 
prepared with chickens or pigeons' meat, mutton 
or beef, mixed if possible with the broth pre- 
pared from calf's'feet, and later on eggs and 
meat extract may be added. Toward the last 
days of the sickness meat may be allowed even 
if fever should still be present. Raw beef -steak 
ur the ordinary steak— chicken or pigeon are 
to be preferred . 



In case the appetite i.s A^ery strong I order a*^ 
long as liquid nourishment is given once or twice 
a day a dose of bi-carbonate of soda after the 
meal. 

All the rest of the conditions and require- 
ments of the hydriatic treatment must be fol- 
lowed out consistently and energetically, fresh 
air must be abundant, and the nursing perfect. 
Each case which recovers may be counted a 
master-piece, so to speak. Without the support 
of the friends and the persons who do the nurs» 
ing, success is impossible. 

In case it has been possible to bring forth 
some measure of improvement by these means, the 
energy of the treatment may be cum grano salis 
somewhat reduced. Short lukewarm half -baths 
with a moderate amount of affusions are useful 
in helping on reconvalescence. Two to three of 
such are generally sufficent, later one, two, at 
last but one. The compresses to the abdomen 
are kept up to the last, but changed at greater 
'intervals, ahvays however after eating. 

In the majority of cases this line of treat- 
ment can be carried out and is sufficient to save 
the patient, if such a thing is possible. Only 
very rarely, in very desparate cases, where life 
is hanging by a thread as one might say, and 
where one might hesitate to take the patient 
from the bed into the bathtub, we recomend 



to prepai'e the patient for the bath by washing 
the whole surface of the body with the wet hand 
every half hour, and by the application of cold 
rather wet compresses to chest, abdomen and back 
also to be changed every half hour. In case 
that under these procedures the symptoms 
improve and the pulse grow stronger, the bath- 
ing ought to begin without much loss of time. 

The Treatment of the Symptoms and the 
Special Forms of Degeneration. 

The condition of the brain and nervous 
system in the degenerated typhoid is not any 
more that of the normal typhoid. This conclu- 
sion can be formed by considering on the one hand 
the readiness wuth w^hich apoplexies, paralyses and 
convulsions occur, and on the other, the diffi- 
culty which is experienced in renewing the 
somnolent condition and the coma, or in other 
words to bring back the patient to conscious- 
ness^ a feat not so very difficult in the manage- 
ment of the normal typhoid. Remembering the 
long time that detrimental influences have been 
acting on the brain and nervous system, the 
great depression of their functions, the malnu- 
trition of these organs continued w^eek after 
w^eek, the hyperaemic condition during the 
period of exacerbation, and the insufficient 
equalization, due to the great depression, in the 



time of the remission, considering further that 
degeneration only takes place if the condition of 
the brain and nervous system have been deeply 
altered, the supposition of material changes in 
these organs becomes a certainty. It is true 
the post mortem examinations do not reveal 
such facts, which would explain these marked 
s3^mptoms. Nevertheless the anaemic condition 
of the brain, pointed out by Buhl , its infiltra- 
tion with a serous fluid and the accumulatron 
of serum in the ventricles may explain a part 
of the symptoms. In all probability there 
exist material changes in the brain and nervous 
system, which the means at our command at pres- 
ent, do not reveal, and the recognition of which 
must be left for a future period of time. 

The direct consequences of these changed 
conditions of the nervous organs are a paralytic 
condition of the brain, of only two frequent 
occurrence, apoplexies, paralyses of different 
parts of the body, psj^choses, mental weakness. 
The indirect consequences brought about by 
deficient regulating influence of the brain are 
incomplete recovery, chronic condition of ill 
J)ealth, and sequelae of all sorts. 

As far as treatment is concerned, water is 
as powerless as any other remedy to influence 
these alterations directly. All what can be done 
is to take good care of the function of the brain 

14 



— 210- — 



vet intact, and gradually to conduct it back to 
the normal condition, or in other words to raise 
the semi -paralytic condition of the brain and 
nervous system, to support their regulative 
functions to aid in the excretion of morbid pro- 
ducts and to accelerate the formation of new 
blood. 

The ( cer.<((tile) form of the affection of the 
brain characterized by excitement and restless- 
ness (ataxia) demands greater caution than the 
(adynamic) form in which the patient lies qui- 
etly on his back in a condition of deepest 
unconsciousness. While in the latter form vig- 
orous local applications of the water to the head 
and even to the whole surface of the body in 
the form of affusions are applicable and their 
frequent repetetion necessary, in the former 
variety anything like shock is to be avoided, 
the temperature of the water must be high, 
att\isions are sparingly to be used and a pro- 
hmged action of the bath is demanded, as has 
been described previously. 

[I add here the passages to which the fore- 
going words refer, from an earlier part of the 
I )ook . 8 . ] 

On the whole (im (^rossen and Ganzen) it 
can be said that the treatment of the atactic and 
adynamic forms does not differ essentially. In 
case there is present neither degeneration of the 



211 



process uor any such complication as alcoholism, 
the ordinary treatment will be sufficient to gain 
the desired result. 

There are however exceptional cases, where 
it is important that the physisian should find the 
reasons for in order to remove the obstacles. 
Thus in observation No. 11, an excessive irrit- 
ability of the brain was the cause. 

, It is more frequent for the treatment to fail 
to bring about the desired result in the atactic, 
than in the adynamic forms of the disease. 

For the atactic form I should recommend 
baths of a higher temperature and of longer 
duration and affusions only in a moderate degree 
baths of 25—22^ C. (77—72^) F. of 15—20 
minutes duration and nothing like brusque 
affusions, but only a gentle but continuous cool- 
ing of the head. In the first half of the sick- 
ness a dose of morphine (0,02 grm.) ^ grain is 
often exceedingly useful and in the latter half 
especially if sleeplessness should continue for 
some time, wine in large quantities. 

In the adynamic forms however if the gen- 
eral formula should not be sufficient a more 
energetic form of treatment is applicable, either 
full-baths of 10—12° C. (50—54° F.) (after 
Jurgensen and Heuhnev) of 10 minutes duration 
or, what I prefer, the half-bath of 25°C. (77° F.) 
of 10 — 15 minutes duration with quite cold 



aifusjioiici and energetic rubbing, which will gen- 
erally be sufficient. 

(It must not be forgotten that the directions 
ai*e given for the treatment of normal cases, 
where the resistance to the cooling process is stiU 
great. S. ) 

Particular atfentioii has to be paid to the 
regular evacuation of the bladder. In case of 
retention of of the urine — a bad symptom— the 
bladder has to be emptied twice a day by means 
of the catheter. 

If convulsions set in. the process is discon- 
tinued. One waits until the attack is over; if 
an excessive degree of temperature i^ present, 
this is combatted by cold compressess applied to 
the anterior and posterior surface of the trunk, 
and before a new bath is given the question is 
to be considered, if not the attack was called 
forth by the form in which the water was admin- 
istered. Perhaps the water had been too cold 
and the shock produced the attack, and a - fresh 
one may be avoided by using warmer water for 
the next bath. 

Psychical disturbances in the form of mani- 
acal or melancholic delirium, do not demand a 
change in the proceedure. The chief indication 
has to be satisfied and where side-indications 
exist these will be met without difficulty by 
attending to the princii^als laid down. 



— 213 — 



In the treatment of grave, typhoid brain 
affection?i one ])omt must not be lost sight of. 
viz: sleep, Griesinger speaks to the point, 
when he says: ''Of whatever character the dis- 
turbance of the brain and nervous system may be 
and of whatever intensity, from the mildest 
disturbances to the gravest status nervosus, one 
thing alone will restore the normal equlibrium 
and relieve the condition — sound healthy sleep.'' 
Of course sleep must not be confounded with 
stupor. 

To produce sleep by means of the water- 
treatment will generally present but little diffi- 
culty. After the chill has passed away it is an 
exception to the rule, if sleep does not set in 
to colitinue until the next exacerbation makes 
itself felt. 

In case sleep should not set in the charac- 
ter of the bath has to be modified, only in case 
of extreme necessity should morphine be used in 
the degenerated typhoid. 

(On the other hand, if narcotics had been 
administered all along during the course of the 
sickness it would not seem wise to discontinue 
them. 8.) 

Amongst the ((hdondnal stjmptotnn meteor Ism 
and hemorrhage demand attention. The meteor- 
ism is generally reduced to a low degree by the 
general procedure and tlie compresses, which 



— 214 — 



improvement continues until reconvalescence is 
established. This moderate degree of distension 
does not inconvenience the patient and will 
hardly be noticed by him. In very grave forms 
of the disease however, where the muscular 
coat of the intestines is almost paralysed, and 
the distension therefore extreme, the action of 
the water is not so conspicuous. Under such 
circumstances, if one wishes to do something 
besides using the water, charcoal may be used 
according to ScJtarlau or Bang or calomel which 
Friedreich recommends so highly. 

The intestinal hemorrhage*of typhoid fever 
is either due to lesions of the capillaries or the 
arteries. I distinguish therefore a true and and 
a false hemorihage. In false hemorrhage the 
faeces contain only traces of blood, or blood is 
voided in small (j^uantities only.** 

(Here I (S.) should like to insert a passage 
from another part of Brand's book. Although 
not concerning the degenerated typhoid in par- 
ticular it discusses the question whether the 
baths are to be discontinued in case that blood 
appears in the discharges.) 

•'xls far as intestinal hemorrhage is con- 
cerned, I formally advised the discontinuation 
of the baths, not for the reason that the baths 
produce a congestion in the intestinal mucous 
membrane — which is not tbe case, but because 



— 215 



I was of the opinion that movements necessarily 
connected witli the bathing had better be 
avoided. All observers have followed my exam- 
ple, more on account of the first (false) reason 
than on account of the second one. To-day I 
am sorry that I did set up this contraindication. 
Reading the reports it can be seen that there 
was too much readiness shown in stopping the baths 
and that tJius the patient in order to escape the 
minor danger was exposed to the greater of suc- 
eitmhing to the fever. I believe that the principal 
to discontinue the baths, as soon as blood appears 
in the discharges is false. The correct principle 
is this: TJte baths have to be discontinued in true 
hemorrhage, that is, ivhen the loss of blood makes 
it percepjtible in the pulse and the tempjerature. 

If that is not the case the baths have to be 
continued and all that is]|necessary is to be as gen- 
tle as possible in transporting the patient into 
the bath and back into bed. Nobody has offered 
any evidence to show that the bath is instru- 
mental in producing hemorrhage. I recount 
six cases of false hemorrhage, as I call it 
Tcapillary) where the bathing was not interru])- 
ted for a moment and the fever took its normaJ 
course.. Mr. Glenard has gone on with the 
bathing even when true hemorrhage was present 
without any harm being done. Further, Mr. 
Soulier has shown experimentally that the cold 



— 216 — 



bath produces not an increased redness but 
pallor of the intestinal mucous membrane. It 
would thus appear that there is no causative 
connection between the cold bath and intestinal 
hemorrhage. This view is further supported by 
by the observation pointed out by Wunderlich 
that hemorrhages rarely occur during or immedi- 
ately after the bath, but generally several hours 
later, that repeatedly compact faecal discharges 
take place between the bath and the bleeding, 
and above all by the fact that the water treat- 
ment deminishes the frequency of the intestinal 
hemorrhages.'' 

The capillary hemorrhages may, according 
to Brand, be due to excesive hyperaemia attend- 
ing the pathological changes in Peyer's patches 
or to slowly healing ulcers in a later stage. 
These hemorrhages are generally small in amount 
and demand but little attention. The variety 
of capillary hemorrhage irom the bowels, which 
is a part of the condition generally named 
^^dissolutio sanguinis" and accompanied by 
bleeding from other organs is generally fatal and 
not amenable to any treatment. 

The true intestinal hemorrhage due to the 
formation of sloughs and the arrosion or arterial 
vessels is apt to be large in amount and to make 
itself felt by a rapid pulse and all the symptoms 
of collapse, 



— 2ir — 



AVhat Brand has to say on the treatment 
is the following: -'The conditions present when 
arteriel hemorrhage occurs in a case of typhoid 
fever; are more unfavorable than under other 
circumstances, because the blood on account of 
a deficiency of fibrin and albumin has no tend- 
ency to coagulate and thus makes it difficult for 
the openings in the arteries to be plugged with 
coagula, and because the decreased contractility 
of the arteries interferes with the formation of 
thrombi. To this has to be added that the 
diarrhoea, which usually is present, does not 
allow the necessary rest of the diseased part, 
and that the fluid contents of the intestines 
readily carry along with them the live-saving 
coagula, and that the condition of the nervous 
organs does not support the efforts of medical art. 
The importance of the latter against these com- 
plications is too evident. The fatal issue is the 
rule and hemorrhages which end favorably are 
almost all of capillary origin. 

Nevertheless it would not be proper not to aid 
the organism as far as it is in our power. 

For this purpose absolute rest of the body 
is prescribed, in cases of arteriel hemorrhage, 
abstension from eating as far as this is compatible 
with the maintainance of life, and cold com- 
presses, which must never be allowed to become 
warm , to the abdomen , for a period 3 — 4 days . The 



— 218 — 



baths are discontinued. To place the patient 
into the bath-tuli and back to bed would inter- 
fere too nuich with the first demand of absolute 
rest. Fever must be combatted with quinine 
and thirst with small pieces of ice placed on the 
tongue. 

If hemorrhage returns, it may be advisable 
from a moral standpoint, to administer styptic 
medicines. The liquor ferri chlor,, and the 
plumb, acet. are recommended. I prefer the 
hypodermic injection of ext. ergot. (Bonjean.) 
Formerly I have used iced enemata but consider- 
ing that absolute rest of the intestinal canal is 
absolutely necessary for the occlusion of the 
vascular erosions, 1 now omit them, and should 
prefer to recommend large doses of o^Dium. 
Constipation lasting a number of days is certainly 
advantageous. After 3 — 4 days when it is 
probable that tlie vessels have been closed, the 
bowels may be opened by cold water enemata, to 
remove the decomposing blood. 

After the hemorrhage has ceased a number 
of days, a careful effort to replace the loss by 
proper diet, wine etc, may be made and gradu- 
ally the ordinary course of treatment can be 
taken up again. 

In the epidemic of 185^-9 I met five cases 
of genuine intestinal hemorrhage of which one 
died; since then I have not met any further cases. 



— 219 " 



As far as the respirator y organs are con- 
cerned the following pathological conditions 
need consideration: ulcerations of the larynx, 
hypostatic conditions, inflammation and gangrene 
of the lung, and pleurisy. 

I am of the opinion that some, if not many 
physicians, who otherwise might not be disin- 
clined to use the hydriatic treatment, are deter- 
red from its employment in case chest symptoms 
make their appearance. Lung diseases to ))e 
treated with water is something so novel, and 
the fear of exposing the patient to catching cold 
is a thought which will at once be uppermost in 
the mind, when this idea is considered. T myself 
found it difficult to free myself from the fear of 
harming my patients, suffering from lung affec- 
tions, b}" using cold water. If however the 
water is employed in a rational way , there is less 
danger here of catching cold than under any 
other form of treatment. I am able to quiet 
timid minds on this point. Aside from a num- 
ber of cases of inflammatory affections of the 
larynx and bronchial tubes I have treated a num- 
ber of pneumonias of every degree of severity, 
either with water alone or in combination with 
digitalis with the most happy results. In case 
of purulent pleuritis where all efforts to mitigate 
the terrible distress of the patient with medicine 
or abstraction of blood were without avail, I have 



220 — 



produced comfort by iiieaDS of the water, have 
removed the most imminent danger and thn.< 
created a possibility for recovery, which, after 
the pus having been evacuated through the 
lungs, took place in a most satisfactory manner. 
I often have suppressed the hectic fever of 
accute tuberculosis of the lungs with this remedy, 
and have been enabled to jDroduce an increase in 
the body- weight. In two cases of children I 
have seen cavities in the lungs, diagnosed by 
others besides myself, heal under the use of 
water, and am in the habit of making whooping 
<*ough run its course in 4 — 6 weeks — never, not 
in a single case, did I see any reasons for com- 
plaint either on account of catching cold or of 
any other harmful incident. All that is neces- 
saiy is to observe the principal, to avoid doing 
too much in the treatment of lung affections by 
means of water, and not to interfere with the 
critical exertions of the system, especially the 
production of sweating in acute affections. 

In ca^^e oi idcerat ire processes in and about 
the lary)LV all local treatment is supei^uous. 
Only general treatment, an improvement in the 
constitution of the blood, holds out some hope. 
Wet application are as powerless as external 
irritants, both being a source of annoyance to the 
patient. In my opinion it should be the aim of 
treatment to bring the general process to a.-* 



iapid a termiuation as possible, and if symptoms 
of suffieation should demand it to perform 
treacheotomy to gain time for the healing of the 
ulcer. Time is the prime factor in the cure of 
these affections. In case that ulceration spreads 
from the mucous membrane to the cartilages, 
recovery is impossible. 

The hypostatic condensation of the kings, in 
consequence of patholgical changes in the blood 
of a grave character, and of a very low condi- 
tion of the functions of the brain, does not 
demand so much local treatment, as an energetic 
and determined carrying out of the general 
treatment, and a low temperature of the bath. 
Wet compresses applied to the chest are valuable 
aids; nor are affusions to be neglected.^) 

The condition in the presence of catarrhal 
and croupous pneumonia are, as far as treatment 
is concerned, about the same as for hypostatic 
processes. It is always the general typhoid 



•^^jFrom a letter from Dr. Brand: In hj'pastatio con- 
densation of the lungs the ordinary temperature 20° 0. of 
the water i? to be used and water of 10° 0. are used for 
the affusions. The patient sits in the water up to the pit 
of the stomach, so that the thorax remains outside of the 
water. The same is rubed thoroughly. The affusion are 
to be of short duration but to be repeated often, to get a 
stimulating effect, which is the desired object. ' 



alt'ection which will demaDcl most of the att^u- 
tion. while the local conditions deserve but 
minor consideration. 

The principales of treatment have been 
communicated in a former part of the volume. 

(The passages to which Brand refers are the 
following: S. ) 

In as much as the treatment of the croupous 
pneumonia is at present (1877) undergoing a 
transformation, it may not be out of place to 
touch upon this topic in this connection it being 
germane to the question under discussion. I 
assume that the pneumonia under consideration 
is of not a mild character, so that it calls for 
active treatment. For it is well enough known 
that in a large number of cases of pneumonia 
according to the accepted opinion, verv active 
interference is not desireable. and it is better to 
leave the pathological process take its cour.se 
undisturbed. 

When 25 years ago I entered the profession 
the treatment of pneumonia consisted in venesec- 
tion, the use of tartar emetic and a weak infu- 
sion of digitalis. 

Very soon after that the important essay of 
Diet! appeared: Venesection in pneumonia, in 
which the use of blood letting was deprecated. 
The reasons of Dietl could not be gainsaid. The 



— 228 — 



transition from the old to the new line of treat- 
ment was bad. The pnblic, knowing the relief 
which a venesection bronght about in pneu- 
monia, demanded the same, and it iook- years 
before it acquiesced in the withholding of the 
procedure. 

The results of tlie new method compared 
with the old could hardly be called favorable. 

A little improvement was brought about 
by the teachings of Trauhe that digitalis in lar- 
ger doses was to be administered to reduce the 
pulse and temperature. If that could be 
accomplished a certain amount of relief of the 
subjective symptoms as well as a more favorable 
course of the disease could be recognised. 

Unfortunately however it became clear, 
that in a certain percentage of cases this effect 
of digitalis could not be brought about. In this 
class of cases the patient generally would suc- 
cumb to the disease in spite of the use of ipecac 
senega, sulfur, aurat, antimonii, liq, anumonii, 
anis, etc, etc. 

Now and then I succeeded by the use of 
the cold pack and energetically combating the 
fever to produce a change for the better, and it 
was interesting to observe how after the reduc- 
tion of the temperature digitalis at times pro- 
duced its effect now in a supplementary way. 



On the whole however there were no reaS- 
oufi for being proud of the results of this form of 
treatment. Only too often patients died, in 
whose treatment love, care and skill had not 
been spared. 

The treatment was deficient in one impor- 
tant matter, which Juergensen pointed out. 
Through him first the correct indications for the 
treatment of pneumonia were made known. 

If this ingenious observer, who deserves so 
much credit for his labors in the treatment of 
typhoid fever, had written nothing else, besides 
his article on pneumonia in the ''Handbuch der 
Krankheiten des Respirations apparates, Leipzig 
1874. W. Vogel," he would have deserved well 
of humanity for this alone. 

According to Jilrgensen the danger in pneu- 
monia proceeds not so much from the diseased 
organ as from the heart, which suffers at the 
same time under the influence of the fever and 
the lung affection. 

A jmeumonia p<(tieiif die!< from Inrnffielency 
of the heart. 

The aim of treatment therefore consists in : 

(T.) Protecting the heart pro phylacticall y 
against weakness. 

(2.) Removing heart -weakness which has 
developed 



— 225 — 



The prophylaxis is accomplished by keep- 
ing down the fever and the heart weakness is 
combatted by stimulants. 

The first part is self evident and nobody per- 
haps would offer any objections. 

The second part however, in the way in 
which Jiirgensen theorizes about it, is altogether 
new, and demands that his reasons should be 
brought forward. 

' 'The consequences of the heart weakness, ' ' he 
writes 1. c. pg. 171, ''are known to act in plac- 
ing upon the right side of the heart an extra 
amount of labor. Through diminished activity 
of the ventricle a stasis in the pulmonary cir- 
culation is brought about and with it an insufici- 
ent filling of the left ventricle; and in higher 
degrees of this conditon an accumulation of 
blood in the systemic veins partly on account 
of the diflacult outflow into the right ventricle 
which is never entirely emptied, and partly on 
account of the diminished vis a tergo. If this 
condition reaches a very high degree, oedema of 
the lungs may follow^; in fatal cases it hardly 
ever is absent. The emptying of the left vent- 
ricle under all circumstances has this very 
important drawback in its wake; the working 
muscles, heart and respiratory muscles do not 
receive a suflficient amount of blood, which in 
turn endangers in the highest degree their ability 
15 



— 226 — 



to perform their functions. It is therefore more 
correct to assign as the cause of death in pneu- 
monia insufficiency of the heart instead of the 
customary oedema of the lungs." 

To antagonize this insufficiency of the heart 
Jurgensen recommends stimulants. These excite 
the heart to perform more work. Every strong 
impulse of the heart brings, by forcing more 
blood from the over filled right into the left 
ventricle, more oxygen to the heart, removes the 
substances of retrograde metamorphosis, and in 
the first place brings aid and support to the 
heart itself. The stimulant is at the same time 
the whip and the oats for the heart. (Jurgensen.) 

These indications are established for the 
ordinary genuine crupous pneumonia; with the 
introduction of the stimulants the defect which 
exists in my method is remedied. The question 
now arises whether these indications will hold 
good for the genuine secondary pneumonia of 
typhoid fever. 

The pathological process , the conditions in th& 
lung, being the same here as there the same indi- 
cations can and must govern the treatment. 

The only difference, which exists, is that 
here we have before us a reconvalscent from a 
disease which is characterized by intense affec- 
tion of the lungs and fatty degeneration of the 
heart. These dangerous complications must be 



— 227 — 



taken into account; they are the principal source 
of danger. But when, even in the genuine 
pneumonia, the issue of the cases depends not so 
much on the intensity of the process, as on the 
resisting power of the organism, this holds good 
in a higher degree in the secondary pneumonia. 

The means to combat the fever in genuine 
pneumonia are digitalis, veratria, quinine and 
the cold bath. Other means there are not in 
existence. (1877. S.) 

The first two remedies cannot be employed 
in secondary pneumonia because they are apt to 
produce collapse, for which the patient is dis- 
posed already, and which under all circumstances 
must be avoided. 

Quinine meets the condition better, of which 
Jurgensen says, that it reduces the temperature 
without being detrimental to the heart, which 
fact however Lindwurm combats. Against 
the way in which Juergensen has advised quinine 
to be administered objections can hardly be made. 

But quinine is not powerful enough to 
reduce the fever in a sufficient degree in pneu- 
monia. Recourse must be had to the cold bath 
which finally is and will remain the most simple 
and reliable antipyretic which we have. 

A pneumonia case in a bath of 10° C. tem- 
perature — the very idea is enough to make the 
old-school physician shudder. 



— 228 — 



The cold bath however, used in the right time- 
in the right icay, and with the necessary precau- 
tions in the treatment of pneumonia is not only- 
free from all danger, but is the most reliable 
sheet-anchor, especially in those cases ichere in 
consequence of the attach of typhoid fever ichich 
had preceded the pneumonia the heart has suf- 
fered. 

Together with Mr. Glenard I have treated 
during the winter of 1870-1 29 cases of pneu- 
monia of the gravest character in this way 
without loosing a single case. 

By the right time is to be understood the 
febrile stage of the disease up to the time when 
the crisis is to be expected, to the end of the 8th, 
latest the 9th day under the conditions prevail- 
ing here. After that period the bathing is dis-^ 
continued, even if the temperature should be high, 
in this stage stimulants (wine) only are in place. 
Pneumonia of shorter duration I am not 
acquainted with, if such should occur the 
appearance of the crisis would be the indication 
for the cessation of the baths, 

Further, I understand by the right time the 
correct determination of the number and time of 
the baths. AVhile during the course of the 
typhoid fever the indications of keeping the 
fever down is absolute, it is sufficient in the 
treatment of pneumonia to keep the same 



— 229 — 



within moderate bounds, to bath perhaps only 
:at 40 

As precautions finally are to be mentioned 
the stimulation of the heart before and after the^ 
'bath by some strong stimulant — if necessary the 
avoidance of the shock and an equable abstrac- 
tion of heat by keeping the patient in the water 
up to his neck. 



* From a letter from Dr. Brand: "All observers 
agree with me, that when a pneumonia is found in the 
43eginning of treatment, or if the same sets in in the course 
oi treatment, the general principles, of the treatment of 
1;yphoid fever have to be adheared to, and one continues in 
the treatment as though the pneumonia were not present. 
If however it sets in aftor the typhoid-fever-process proper 
^has run its course, that is secondarily, it is perhaps better 
not to bathe at 39°C and below that, but only when the 
temperature has reached 39, 5°C excepting in the presence 
^of great cardiac debility when a circumstance which would 
demand frequent stimulations. It need not be mentioned 
that the stimulating compresses — not ice — are of great 
Importance to the heart — and this keeps the nurses 
engaged, so that it cannot be said that nothing is being 
done for the patient. ^ 

How often is the bath to be repeated? Our answer 
to this question follows from what has been said above. 
At 39,5 C if the fever is the one domineering factor; 
-every three hours if the heart has the upper hand. In 
• case the heart is two weak, something not often the case, 
-.the compresses and alcoholic stimutants have to do their 
part." 



— 230 — 



Under certain conditions a strong revulsion? 
hj powerful frictions and warming up of the- 
^extremities after the bath are of great value. 

If heart-weakness in spite of all this sets in 
or if it is present when the patient comes under 
treatment, the temperature at the same time 
being high, the delicate question arises, is a bath 
to be given or not? 

This question forms a difficulty Avhich 
baffles almost every one. Hie Rhodus, hicsalta.. 
If for the insufficiency of the heart nothing is 
done, the fever is not combatted, the patient is 
lost — so much is certain. 

Juergensen says on this point, 1. c. pg. 177,. 
*^The bath for the time being augments the labor 
of the heart but on the whole diminishes the 
same. If it is able to perform the transient 
extra exertion the bath is to be given; in the 
opposite condition, not. As a practical rule: 
In case that a very severe condition of collapse is 
not present, then by using the necessary care in 
the selection of the stimulants and the tempera- 
ture of the baths, the majority of the patients 
can be treated by direct abstraction of heat and 
must be so treated because the most dangerous 
enemy to the heart is the elevated temperature, and 
to make the same innocuous there is no more- 
reliable remedy than the cold bath." 



— 231 — 



This proposition will be admitted as true, 
even if in case of an unfortunate issue the phy- 
sician and his method will have to bear the 
blame, the conscientious physician ought not to 
allow the possibility of saving the patient in 
this way to pass by untried. 

Furthermore as the gradually cooled down 
full or half -bath are the proper modifications of 
the treatment to meet such cases, any reproaches 
could perhaps be avoided or at least be weak- 
ened. 

To recapitulate: The treatment of pneu- 
monia consists of the administration of quinine, 
the stimulants and the cold bath. These are 
the agents of the hydriatic method. 

One is justified therefore in saying: The 
hydriatic treatment of the late and secondary 
pneumonia of typhoid fever, meets the indica- 
tions completely. 

He who does not wish to make the unpleas- 
ant acquaintance of a primary pneumonia in 
typhoid fever will only have to follow the prin- 
ciple of using the baths regularly and from the 
very beginning of the sickness. 

Does the same for any reason nevertheless seem 
imminent colder baths 16° C. (61° F.) have to be 
used and ice water for the affusions and a daily 
curve of the average temperature be drawn to 
controls the nursing, to see whether it has been 



— 232 — 



carried out without any faults and short-com- 
mings. This proceedure is kept up even if the 
pneumonia actually develops. Under no circum- 
stances should warmer baths be used or the 
bathing be discontinued. 

To prevent secondary pneumonia the half- 
bath is applicable after the fever has gone down 
aud a proper protection of the patient against 
changes of temperature. In the treatment 
of the same the ordinary principles are to 
be foUowed only that 40° C. (104° F.) is 
the temperature when a bath is to be given and 
chest compresses — also to the back are to be 
applied. 

Gangrene of the lungs I have observed twice, 
once the patient recovered, the other case, where 
both lungs were affected, succumbed. This form 
of the degenerated typhoid is not so rare, D. A. 
AYilligk mentions in his report on the pathologi- 
cal institute in Prague, that it occurred there 
twelve times within four years. 

The prognosis is bad, Vogf saying that these 
cases are always fatal. Yet Lebert mentions a 
case which recovered and Lederer a similar 
case of a twelve year old girl, which also recov- 
ered. To this my case is to be added. 

AS far as treatment is concerned the local 
besides the general was almost nil. The blood 
changes are so profund, the functions of the 



— 233 — 



nervous organs at such a low ebb, the organism 
in all its parts so deeply involved, that the dan- 
gers which present themselves from hour to 
hour and from day to day demand all the atten- 
tion. To keep the patient alive from hour to 
liour is the chief aim; everything depends upon 
time. One must accomodate oneself to the 
changing condition of the patient and apply the 
principles which have been laid down. The 
gradually cooled down full bath will under such 
conditions be of the highest service." 

(The paragraphs on erysipelas, decubitus, 
pyaemia have been omitted, because no special 
modifications of the use of water is mentioned to 
meet these conditions. Of course the general 
hydriatic treatment, when they are present, is 
not omitted by Brand. S.) 

If others will read the directions for the 
treatment of the complicated and degenerated 
cases as I do, they will have some difficulty in 
putting them to practice and that for a number 
of reasons. In the first place Tripier and Bou- 
veret and Brand do not harmonize in every par- 
ticular as they do in the treatment of the normal 
<jases; thus the French observers advise not to 
use cold affusions while Brand devotes a page 
tnd more to point out its usefulness. In the 
matter of decubitus also T. and B. discontinue 
he bathing if the same is extensive, while 



— 234 — 



Brand goes on with the treatment, as though it 
were not present. Likew^ise in the directions 
of Brand I find some discrepancies. Thus the 
special directions of treating atactic and 
adynamic cases do not harmonize with the gen- 
eral directions for treating the degenerated cases^ 
there being some discrepancy regarding the tem- 
perature and the duration of the baths, and like- 
wise the directions for the treatment of the lung 
complications do not harmonize with the general 
rule. A second difficulty is, that the directions- 
are not specific enough to meet all cases which 
we may find. Considering the great variety of 
cases and conditions and the different constella-^ 
tion of symptoms that must occur par excellence 
in this class of cases, it cannot be expected that 
in the short number of years that the water treat- 
ment has been employed, that in this matter, full 
and final rules should be established, which 
w^ould meet every case coming under observa- 
tion. Thus during the last few years I met a 
few cases, w^hich I had not the opportunity to 
treat with water, and the treatment of which I 
do not see described in the writings of Brand 
or Tripier and Bouveret. They were cases 
which to put the matter in short language, had 
forgotten to get better; they fitted in none of 
the classes of the preceeding paragraphs; none 
of the complications were present and none of 



— 235 — 



the symptoms were extremely severe. Yet they 
died. 

Nevertheless there are a few extremely 
valuable rules, followed by Brand as well a& 
Tripier and Bouveret. and these are (1.) that 
the longer the fever has lasted the less resistance it 
offers to the cooling process — hence baths both cool 
and long (fifteen minutes^ will not often be indi- 
cated. (2.) The stimulating action of the water 
and not so much the cooling is what is indicated 
here, hence shorter baths, the luke-warm half -bath, 
with affusions, the Ziemssen bath, short cool baths 
(perhaps) are to be used, (3) The patient must be 
watched closely, the effect of the baths studied and 
any necessary change made; and in giving the first 
bath one must keep on the safe side. After it 
has been shown how the organism reacts, more 
energetic means can be used. 

Keeping these rules in mind, studying the 
cases in Chapter IV, and reading repeatedly the 
foregoing paragraphs, so that one will enter into 
the spirit of the method will certainly be of a 
great deal of aid to manage these difflcult cases. 
Diet, Hygiene, Medication. 

The regimen as far as diet is concerned does 
not differ from that employed under any other 
way of treatment, expectative or medicinal. 
During the acme of the disease liquid nourish- 
ment, only coffee, tea, broth, milk, a cup at a 



— 236 — 



time are to be given. The advantage of the 
hydriatic treatment is that the patient is able to 
take and digest the nourishment which the books 
demand that he should. It is important to keep 
in mind that the best time for the feeding of the 
patient is about fifteen minutes after he has left 
his bath, when he begins to feel comfortable and 
ready to go to sleep. During the period of def- 
ervescence the broth may be made more nutriti- 
ous by the addition of the yolk of an egg by 
T3oiling it with barley, farnia, rice etc. (straining 
it of course.) 

Three to four days after the disappearance of 
the fever more solid food is allowed, bread and 
l)utter, mashed potatoes, light meats — but in this 
matter the hydriatic method has no particular 
advice to offer. 

It is very important that the patient should 
drinlc much. Brand advises his nurses to offer, 
in case that the patient does not sleep, the pati- 
ents some drink every 15 minutes. T. and B. 
:always have the patient drink a glass of water 
-during the bath. Vogl has them take in the 
middle of the bath and towards the end wine, 
tea, punch; 500 — 1000 c c. of French wine (1 — 2 
pints) or 100 — 150 grms, (3 — 5 ounces) of whis- 
key, if stimulants are indicated, can be used per 
day. T. and B. say that some of their patients 
liave taken 2 — 3 litres (2 — 3 quarts nearly) of 



— 237 — 



water or other drink, as lemonade, Selters- water 
wine-and- water. Liberal drinking will produce 
an abundant flow of urine, which is desirable,, 
as in this way, as it seems, noxious matters are 
rinsed, so to say, out of the system. The fluids 
which are offered to the patient ought as a rule, 
to be cold. 

Fresh air is necessary and a large quiet room 
is desirable. Vogl treats his cases in a frame 
building abundantly supplied with windows and 
has constantly some of the windows open even in 
the winter time, so that at times the tempera- 
ture in the pavilion is near the freezing point. 
This seems to aid the cool baths, but must be 
very unpleasant to the attending nurses and phy- 
sicians. It certainly seems to to be benificial tO' 
his patients. 

The evacuations are either burned or disin- 
fected. 

The nurse ought to keep a record of all the 
measurements of the temperature and should 
note the amount of urine secreted in 24 hours. 

Are medicines to be given f No medicines 
should be given that are intended to act as sub- 
stitutes for the bath, such as the modern anti- 
pyretics, antipyrin, antifeloni, phenacetine^ 
sodum salicylate etc. If they are given in strong'- 
doses they produce a condition of the system, 
which cannot always be looked upon without 



— 238 — 



:appreliension, they merely cover up in ray opin- 
ion, the real danger, they have not the benefic. 
ial effect on the pulse, digestive and urinary 
functions, the depression of temperature is fol- 
lowed by a more intense rise, the system very 
soon becomes accustomed to their influence, and 
what is perhaps their worst draw-back, they 
interfere with the systematic administration of 
the baths and the patient is debarred from the 
good effect of these. As a matter of fact, under 
their systematic use in Berlin the mortality was 
24 per cent, as high as under expectant treat- 
jnent if not higher. 

Quinine will ordinarily perhaps do not 
much harm and do not much good, excepting in 
the later stages, but should not be ommitted in 
malarial regions. 

The mineral acids certainly do not inter- 
fere with the water-treatment, nor do the opi- 
ates, bismuth, ergot and turpentine. I certainly 
should not discard them. Calomel is a remedy 
which may be useful at times. VogI however 
declines to use it as a routine practice. 

Resume. 

1. The general formula is: a bath of 20°C 
(68°F.) every three hours, night and day when 
the temperature of the patient is 39°C. (102,2° 
F.) in the rectume. Affusions and compresses. 



— 239 — 



2. Bathe your patients from the begin- 
ning. 

3. Bathe as many cases as possible. 

4. The cold full bath is the most useful, 
-convenient and generally adaptable form of the 
-application of water, at the same time stimula- 
ting and cooling; the tepid full bath with affus- 
ions, the most pleasant, the tepid half -bath with 
•cold aft'usions, the stimulating bath par excel- 
lence, the Zieimsen bath, the mildest form. 

5. Remember that the action of the cool 
bath consists not only in the reduction of the 
temperature, but that the stimulating, protec- 
tive, prophylactic effect is of no less impor- 
tance . 

6. Watch the effect of the baths in the 
first days and modify the treatment accordingly. 
In severe cases with high fever the baths must 
be given colder, or oftener, or must be of longer 
duration. 

7. Remember that in the later stages of 
the disease the resistance to the baths is less than 
in the beginning, so that the milder measures 
now are indicated : a short cold bath. Ziems- 
sen's bath, the warm half bath with cold 
affusions. 

8. In the later stage watch the pulse, and 
be liberal in the use of alcohol. 



— 240 — 



9. Children bear well a short but cool 
bath. For persons advanced in years the Ziem- 
ssen method generally is applicable. 

10. Pregnancy, the puerperal state, obes- 
ity, heart disease, phthisis, pneumonia, bronch- 
itis are no contra indications. 

11. The only obsolute contra indications 
are, perforation peritonitis, thrombosis, intestinal 
hemorrhage, severe enough to lower the temper- 
ature and pulse. 

12. No harm is done to bathe fever cases 
even if the diagnosis of typhoid-fever is not cer- 
tain. 

13. See that your patients take a good 
deal of drink. 

14. The best time to nourish the patient 
is 15 — 30 minutes after the bath. 

15. In mild case the method is not useless 
but will produce more comfort than any other 
remedy. 

16. Inform your patients and their friends 
beforehand about the physiological effects of the 
bath, that they will not feel alarmed about the 
shivering, the cold hands and feet, the impalpa- 
ble pulse etc. 

17. If possible be present at the first cold 
bath to awake confidence in the patients and the 
attendants. 



— 241 — 



Important Advice. 

1. Introducing the method in a community 
select a case which will surely get well, that is 
let it be a case which you can treat from the 
beginning, and where the method will be carried 
out accurately, so that a valuable method do not 
come into discredit. 

2. '^If you will follow my advice you will 
\_at first] only treat eases which come under 
treatment in the beginning of the disease; after 
having become well acquainted with the effects 
of the bath, both the antipyretic and the stim- 
ulating; — venture to take hold of the critical 
ones of a later stage.'' (From a private letter 
from Dr. Brand.) 



16 



CHAPTER IV. 



Illustrative Cases. 

When I began using the hydriatic method 
I felt the want of naving read a detailed des- 
cription of a number of cases, ^^othing will in 
my opinion make up for the want of personal 
clinical experience so well as accurately des- 
cribed cases. I have selected therefore from 
the writings of Tripiev and Boiiveret and of 
Brand a number of such cases, mild ones and 
severe ones, some requiring many, some few 
baths, cases presenting a variety of compli- 
cations and cases surrounded with difficulties. 
I think that after having read such cases one 
will proceed in ones' work with more confi- 
dence and less worry, and I hope I have in this 
respect met the wishes of the indulgent reader. 
The first five cases are from Tripier and Bonveret 
the remainder from Brand. Some of these cases 
are described in such detail — each measurement 
of the temperature and each bath being noted 
dowm — that these may be taken as a guide for 
the execution of the method. 

Other cases will give directions how to act 
when complications and symptoms of unusual 



— 243 -r- 



-gravity are present, and still others are inserted 
to encourage those who may meet apparently 
insurmountable difficulties. 

Oase I. Leontine, W., 16 years of age, received 
into the Hotel Dieu August 25th 1885. Mother, a brother 
and sister also sick with typhoid, another brother has died 
from same disease a few days ago. She always had been 
healthy. Menstruation showed itself at 15 aet. without 
pain. The illness began August 23rd when patient had a 
chill and a headache, lost her appetite and had to go to bed. 

August 2Hth, on the day of her admission (6th day of 
illness:s No grave nervous disturbances, no stupor, no 
delirium, but considerable weakness, high fever, T. 
40,7; P. 120, regular, complete loss of appetite, tongue red 
on edges and on point, dry, with some aphthous ulcers, 
diarrhoea 4 — 5 times daily, abdomen soft, little painful, 
borborgymi, nose-bleeding absent, no roseolae, heart and 
lungs normal. She patient was bathed at once after the 
ordinary formula. The first bath at 4 p.m., until midnight, 
the following temperatures were found. 

Before the bath(18°)40, 2, after the Bath 39,8 
40,6, 39,9 
■ " 40,7, " " 39,8 

August 29th. The reductions after the bath are quite 
marked, the maxima however remain very high. From 
10 a. m. on the T. of the bath is reduced to 16°. 



August 30th. Diarrhoea not yet diminished; 2 — 3 
evacuations, even during baths. Baths of 16° to be con- 
tinued but to be given every 2 J hours. 



Forenoon. 



Afternoon. 



B. B. 40,8, A. B. 39,9 

" 40,3, " 39,8 

39,9, " 39,3 

(16°) 40,2, 39,8 



B. B. 40,8, A. B. 39,4 
" 40,4, 39,2 

" " 40,6, 39,7 



— 244 — 



Forenoon. 
B. B. 40,6, A. B. 39,5 
40,4, 39,6 
40,2, 39,2 
40,1, " 39,3 
40,6, 30,5 



Afternoon. 

B. B. 40,5, A. B. 39,^' 

" 40,3, 39,9 

40,6, " 39,8 

" 40,1, " " 38,2 

" 40,7, 88,9 



B. B. 40,1, 
" " 40,4, 
40,3, 
" 40,5, 



A. B. 38,3 
" " 38,2 
38,6 
" " 38,3 



August 31 St. A few roseola spots appear. Diarrhoea, 
continues. Apthous ulcers on tongue. Baths as yester- 
day. 

B. B. 40,6, A. B. 38,3 
40,1, 39,0 
" " 40,0, " 38,4 
40,0, 38,9 
" 40,3, 38,5 
September 1st. Diarrhoea much diminished. No 
dangerous symptoms. A slight hoarseness. Pharynx a. 
little red, covered with mucus. New eruption of roseola.. 
Treatment the same. 
B. B. 40,3, A. B. 38,4 
" 40,0, 38,1 
40,0, " 38,3 
39,3, ^' 38,4 
40,5, 38,3 



B. B. 40,4, A. B. 39,1 

40,2, " 39,0 

" 40,7, 39,3 

40.4, 39,5 

40.5, 39,6 



September 2nd. Condition satisfactory. Xo more 
fever. The baths produce still greater reductions, often 
exceeding 1°. Treatment the same. 



B. B. 40,4, A. B. 38,5 

^' 40,1, 39,0 

40,0, " 39/2 

" 40.6, 39,0 



B. B. 40,3, A. B. 39,4 
" 40,0, 38,7 

40.1, 38,2 

40.2, 39,0 
39,6, " 38,2 I 

September 3rd. In spite of the strong reductions of 
temperature the fever ascends rapidly afier each bath. Con- 
tinuation of treatment. Each bath of 16° is followed by a 



— 245 — 



^hill, lasting at times an hour. Diarrhoea still more di- 
minished. Hoarseness almost disappeared. Some aphthae 
^nd pain in pharynx. 



B. B. 40,4, A. B. 39,2 
" 40,0, 38,7 

" 40,1, " 38,2 
" " 40,0, " " 38,4 

" 40,0, " " 38,9 



B. B. 40,2, A. B. 38,4 
" 40,0, 39,2 



" 38,2 
38,3 



September 4:th. The same satisfactory condition. 
Diarrhoea has almost ceased; a few cold enematahave been 
necessary. No other disturbed functions but the 
increased frequency of pulse 120. Urticaria on body 
-A little redness and pain in pharynx. No cough. Respi- 
ration normal, without rales. Slight pain in right shoul- 
der. The thermic reductions amouut to 1,5 and more 
From 10 o'clock a. m. on baths of 18° every three hours. 



B. B. 40,4, A. B. 38,5 

" " 39,6, " " 38,3 

" " 40,3, " 38,8 

39,9, 38,1 

(18°) 39,2, 37,8 



B. B. 39,9, A. B. 37,9 

" 39,1, 37,2 

39,8, 37,8 

39,5, 38,1 



Not only are the reductions yery large, but also the 
Guryes of the maxima sink at last down to near 39. Now 
begins the period of relative defervescence. 

September 5th. Status idem. The maxium a little 
higher than 39°. Baths of 20° from now on. 



" " 39,1, 



" 37,6 
" " 37,8 



39,9 

(20°) 39,5, " 38,0 



39,5, 



38,0 
37,8 
'\ 38,3 



— 246 — 



September 6ih. Status idem 

B. B. 39,4, A. B. 38,5 

" 38,5, 38,1 

39,3, 37,4 

" " 38,9, " 38,0 



I 



B. B. 39,3, 
39,1, 
" 39,5, 
- - 39,4, 



A. B. 37, 

38,0 
38,1 
37,8 



September 1th. As yesterday the maxima are at times- 
below 39°. Nevertheless the patient gets a bath when the 
T. reaches or exceeds 38,5°. 



B. B. 38,9, A. B. 37,6 

" 39,6, 37,8 

39,3, 38,1 

" 39,0, " 38,1 



B. B. 38,6, A. B. 37,8 
38,8, " " 37,9 
39,2, 'I 37,5 
38,7, " 37,3 



September 8th, Patient is constipated several days 
Cold enemata. For several days sleep in the intervals 
between the baths. Urine abundant, colorless — no albu- 
men. The thermic reductions being pronounced and the 
maxima below 39 the duration of bath is shortened to 10^ 
minutes, 

B. B. 38,6, A. B. 37,0 \ B. B. 38,7, A. B. 37,5 
" 38,5, 37,6 38,8, ^' 37,6 

" 38,8, " " 37,8 " 38,7, " " 37,4 

38,9, " 37,6 " " 39,1, ^' " 37,^ 

September 9th. The first bath skipped at 4 a. m. 

8 



B. B. 39,0, A. B. 3 
38,4, — 
" 39,5, " '^38,l 
39,3, " 38,2 



B. B. 38,8, A. B. 38,2 

39,2, 38,2 

89,0, 37,7 

" 38,8. 37,5 



After the omission of the tirst bath, the temp, exper- 
ienced a certain elevation, as is often the case; it rose to 
39,5, which, at least in the morning, it had not done for 
.several davs. 



— 247 — 



September 10th. Two baths omitted. 



B. B. 38,7, A. B. 37,8 

" 39,1. " " 38,0 

" " 38,6, " " 37,7 

38,5, " " 

September llth. Cough since two days. Moist rales 
over basis of lung. Some hoarseness, and dryness in 
pharynx. Patient always sleeps well. 



B. B. 39,5, A. B. 37,3 

" 38,8, " " 

" 39,4, " " 38,3 

" 39,3, " " 37,8 



B. B. 38,4, 
39,2, 
39,1, 
38,5, 



A. B. 

u u 37^7 

" 37,8 



B. B. 39,8, 
38,4, 
" 40,2, 
" 39,5, 



A. B. 37,9 

a u 

" " 38,2 
" " 39,3 



September 12th. From 10 a. 



on the duration 
of the baths is reduced to five minutes- In this 
advanced stage very short baths reduce the temperature as 
well as lono^er ones. 



B. B. 38,2. A. B. 

38.8, " 

39,5, 37,9 

38.9, " " 



B. B. 39,3, A. B. 37,6 
" " 39,2, " " 37,8 

^' 38,8, 

39,7, " " 37,8 



September 13th 
Temp, maxima often exceed 39° 

B. B. 38,4, A. B. I 

" " 39,2, " " 37,5 I 

" " 39,1, " " 37,4 

38,8, ^' 

September 14. 

B. B. 38,8, A. B. 

" 39,9, " " 38,2 
" 39,5, 37,3 
a u 38 2 



Slight changes during day-time. 
Complications absent. 

B. B. 39,8, A. B. 37,9 

" 39,6, 37,8 

39,3, 37,5 

39,2, 37,2 



5. B. 39,9, A. B. 37,8 

39,5, " 37,6 

" 38,8, " 

" " 40,0, 38,0 



— 248 — 



September loth. Marked improvement. Hoarseiies 
almost gone. Patient complains of severe pain in 
extremities after bath, especially in feet. 



B. B. 38,6, 


A. B. 


B. 


B. 39,3, 


A. 


B. 


37,4 


" " 38,9, 


u u 




39,7, 









39,5, 


a a 37^7 




39,4, 






37,6 


39,1, 


37,6 


u 


39,8, 






38,0 


Septemhei 














B. B. 39,2, 


A. B. 37,5 


B. 


B. 38,8, 


A. 


B. 





38,8, 






- 39,1, 




^* 


3 7 


38,5, 


u u 




39,4, 




i i, 


37,8 


39,8, 


37,2 




38,5, 









Septtemhei 


■ l7fA. 












B. B. 39,3, 


A. B. 38,0 


B. 


B. 38,9. 


A. 


B. 





38,1, 






39,5, 






38,5 


38,6, 


a a 




39,3, 






38,0 


" 39,3, 


38,2 


ii 


38,6, 









Septemhei 


■ 18^//. 












B. B. 39,5, 


A. B. 37,8 


B. 


B. 39,0, 


A. 


B. 





38,8, 


a u 




39,1, 






37,3 


33,9, 


a a . 




38,5, 









" " 38,7, 


li u 




38,9, 


i i 


u 





Septemhei 


' 19/^i. 












B. B. 38,7, 


A. B. 


B. 


B. 38,9, 


A. 


B. 




" 39,4, 


37,0 










37,2 


37,8, 


a a 


u 


38,8, 




i < 




39,0, 


a 


i i 


- 39,0, 


li 


a 




Septemhe 


■ 'lOth. 












B. B. 38,3, 


A. B. 


B. 


B. 39.0, 


A. 


B 




38,8, 


U ii 


< i 


39,9, 






37,5 


<^ 38,6, 


a u 


i i 


38,3, 








^' 38,5, 


a a 


( i 


38,6, 









— 249 — 



To-day the patient is bathed for the last time. The 
treatment required 151 baths. The general condition is 
excellent. The strength of the patient is preserved. For 
some days the appetite is acute. Tongue clean bright 
Tose red —moist. Four cold enemata daily. Temp, sinks 
more and more. Since last night defervescence very 
marked. 

September 2lst 38,9— 38,5— 38,2— 38,0— 38,3— 38,7 

—38,5—38,6. 
.September 22nd. 38,5—37,8—37,7—38,0—38,4—38,3 

—38,5—38,6. 
September2 3rd. 38,6—38,3—38,9—37,9—38,2—38,5 

—38,7—38,4. 
September 2Uh. 38,0—38,7—37,6—38,2—37,9—38,1 

—38,6—38,5. 
.September 26th. 38,3—38,0—37,6—38,0—38,4—37,9 

—38,3—38,2. 
September 26th. 37,9—38,0—37,5—38,2—38,5. 
September 2lih. 37,5 — 38,2. 
September 2Sth. 37,5. 

From now on the morning temp, is normal. Up to 
October 7th it ran at times to over 38 in the evening. Pat- 
ient leaves the hospital October 11 th fully recovered desir- 
ous of attending to her former occupation. 

This case plainly belongs to grave cases. 
The course it took was simple and regular, pre- 
senting no complication since the treatment was 
begun on the 6th day. Diarrhoea severe in the 
beginning soon disappeared and was followed by 
constipation. 

We recognize the three periods without dif- 
ficulty. From August 24th to September 4th 



— 250 — 



period of combat with the fever. The maxima 
remain in the neighborhood of 40° degrees and 
form a straight line. To vanquish the fever it 
was necessary to reduce the temperature of the 
baths to 16°. From September 15 — 19 perioi 
of relative apyrexia. September 20th the period 
of defervescence begins. The duration of the 
fever — counting up to the day when the temp, 
reaches 37,5 was 43 days. But reconvalescence^ 
took a rapid course. The patient was in the 
hospital only 47 days, and leaving it felt so well 
that she thought herself strong enough to take 
up her old occupation. (151 baths were given. S.) 

Case II. Henriette M. 36 aet. Admitted into 
Hotel Dieu August 25tli, never seriously sick before. 
Menstruation regular since 20 years of age. Had been dis- 
missed from hospital August 14 as cured, Avhere she had 
been treated for lumbago. Until August 22nd she felt 
well, after which she experienced some lassitude. August 
22nd repeated chills, headache, tinnitus aurium, vomited 
3 — 4 times bilious matter — loss of appetite. 

Upon her admission August 25th, high fever, T. 40,4, 
P. 114. Tongue red and dry; complete loss of appetite. 
Constipation since three days. Abdomen somewhat tym- 
panitic. 3 — 4 roseola spots on same, making it probable 
that the disease began before August 22nd. Heart and 
lungs normal. Urine free from albumen. Restless at 
night. Sleep wanting. 

Patient is bathed from the first days of her stay in the 
hospital: a bath every three hours of 15 minutes duration, 
and 20° temp. 



— 251 — 



Before the bath 40,4, after the bath 89,8 
" 39,9, " " 39,5 

" 40,2, " " " 39,8 

August 26th. Menstruation which appeared on time^. 
but which had been interrupted when patient was admit- 
ted, shows itself during first bath. 



B. B. 39,8, A. B. 39,4 

" " 39,9, " " 39,2 

" " 39,7, " " 38,8 

" " S9,4, " " 38,9 



B. B. 39,6, A. B. 39,1 

" " 40.0, " " 39,4 

" " 39,9, " " 39,3 

" 40,1, " -39,4 



August 21 th. Menstruation flows but moderately yes- 
terday. General condition to-day excellent. Some diar- 
rhoea (4 passages.) Five more roseola spots. 



B. B. 39,7, A. B. 38,5 

" " 39,5, " " 38,4 

" " 39,2, " " 38,1 

" " 39,1, " " 38,2 



B. B. 39,3, A. B. 38,0 
" 39,8, " " 38,7 
" 39,5, " 38,6 



40,0, 



39,1 



August 2Sth. Improvement continues. Tongue moist^ 
rose colored. Polyuria; no albumen in urine. The lass-- 
itude of the limbs has disappeared. 



B. B. 39,8, A. B. 38,7 

" 40,0, 38,6 

" 40,3, " 39,2 

39,3, " 38,5 



B. B. 39,2, A. B. 38,4 

40,2, " 39,5 

39.6, 38,4 

39.7, 38,6 



August 29th. The same satisfactory* condition. A 
little pain in right iliac fossa. Sleep between baths. Pulse 
less frequent. 



B. B. 40,2, A. B. 39,2 

" 39,4, 38,9 

" " 39,3, 38,8 

39,2, 38,2 



B. B. 40,2, A. B. 39,0 

39,4, 38,4 

" 40,3, 38,5 

u u 40^2, 38,8. 



August SOth. There is no other symptom left but the 
fever. 



B. B. 40,1, A. B. 38,6 
39,8, " 38,5 
89,8, 39,2 



B. B. 39,9, A. B. 38,2 



39,3, 38,4 
August 31.?/. 



" 39,8, 39,0 
" 39,9, " " 38,9 
" 40,1, 38,7 



B. B. 39,6, A. B. 38/2 
39,2, 37,8 
^' 39,1. - 38.2 



B. B. 89.9. A. B. 38,1 
•• - 39.6, •• 38,8 
•• 39,8, 38,5 



39.6. •• 38.3 39,7. 88,4 

September 1st. The comliat with the fever is finished 
The maxima sink, on the average they do not exceed 39 
much. 



39,1, " 39,1 " 39,4, " 38,0 

September 2nd. Defervescence is beginning. Not 
only are the thermic reductions large, there is also no 
marked tendency for the fever to get back to the old tem- 
perature. Xo symptom but the fever. The patient omits 
two baths. 

B. B. 38,9, A. B. 38,3 , B. B. 39,2, A. B. 38,8 

38.5, 37,8 " " 38,5, " — 
38,0, _ ; 39,4, 88.2 

39.6, 39,0 ' 39,3, 38.0 
After each omitted bath the temperature rises. These 

elevations are of no importance inasmuch as the following- 
bath produces marked reduction in spite of this fact. 

September 3rd. One bath omitted. Condition as sat- 
isfactory as possible. Xo other symptom but high pulse 
and temperature. Xo coughs, no rales. 



B. B. 39,4, A. B. 38,2 
" 39,5, " " 38,1 
" 38,7, " " 38,0 



B. B. 39,2, A. B. 38,5 
" 39,4, 38,1 
u 39^0, 38,5 



— 253 — 



B. B. 39,7, 


A. B 


38,1 


B. 


B. 


38,7, 


A. 


B. 


38,0 


38,7, 


a a 


38,0 




u 


39,0, 




u 


38,2 


38,2, 


u u 








38,1, 


I i 




28,0 


36,6, 


u u 


38,5 






39,2, 


u 


( ^ 


38,4 


Septemhei 


4.th. 
















B. B. 38,3, 


A. B. 




B. 


B. 


39,8, 


A. 


B. 


38,2 


39,5, 


u u 


38,5 


u 




38,8, 






38,1 


38,5, 






i i 




38,3, 




u 




" 38,4, 






i i 


a 


39,1, 




u 


38,0 



The temperature has evidently a tendency to rise after 
the omitted baths, thus it rose to 39,8, higher than for 
two previous days, upon the successive skipping of twa 
baths. 



September bih. 
B. B. 38,9, A. B. 
38,0, " 
38,5, " 

September 6th. 
B. 39,0, 
^' 39,5, 
" 38,1, 



B. B. 38, 



38,3, 



A. B. — 

u u 

37,3 



38,4 



B. B. 39,6, A. B. 37,8 
" " 38,1, " " — 
" " 38,0, " " — 



The two baths of this day were the last ones. The 
whole treatment required 8o baths in all. From now on 
3 — 4 cold enemata daily. 

September 7th. 38,6— 38,2— 38,5— 38,3— 38,4— 38,^ 
38,6—38,2. 

Sepiemder ^th. 38,1—37,9—88,0—37,9,-88,4—88,0 
37,9—88,1. 

Condition excellent, Strength well preserved — appe- 
tite active, Evacuations only after (juinine enemata. 



— 254 — 



September 9th. 38,0—8,32—37,8—38,7—38,7. 

September lOth, The present day is the beginning- of 
complete apyrexia. Temp, taken twice a day for a week 
always below 38°. 

September 14th. Patient is determined to leave the 
hospital, which she does in excellent condition, her recon- 
Talescence being far advanced. 

Roseola being present on the day of her 
admission it is probable that August 25th was 
the 7th and not the 5th day of her sickness, 
according to patients statement. Fever lasted 
23 days, her stay in the hospital 27 days. On 
her departure, when the fever had only left her 
5 days, she was well advanced towards complete 
recovery, wdiich must have been perfect very 
soon. The combat with the fever lasted from 
August 25th to September 1st, about eight 
days. Defervescence which set in slowly lasted 
(as is customary in cases of medium gravity) 15 
days. This case is to be looked upon as a 
typical case of typhoid fever, treated after 
Brand. (80 baths Avere given. S.) 

Oa.se III. JoHX W., 22 aet, admitted September 
^th to the Hotel Dieu. Xo hereditary disease. Scrophu- 
lous affection, swollen lymphatic glands of neck when a 
child. Small-pox at 12 years. 

August SOth. Beginning of sickness with repeated 
chills, feeling of lassitude and herdache. 

September Sth. The day of admission is the 10th day 
of sickness. T. 39,5, P. 116. Patient is rather weak, but 
not restless, Tongue coated, somewliat dry. Complete 



— 255 — 



loss of appetite. Abdomen moderately tender; ileocaecal 
borborygmi. Diarrhoea four times daily. Roseola on 
-abdomen. Headache has ceased, after a nose-bleed fiv^e 
days ago. Heart and lungs normal. No albumen iu 
urine. Patient is bathed immediately after his admission. 
First bath in the afternoon. 



Before the bath 39,5, after the bath 39,2 

" 39,5, " " 39,3 ■ 

u u u 40^2, " " 40,0 

u u u 40^3^ cc a u 4Q^Q 

^' 40,0, 39,8 

September 9th. Lassitude diminished— baths are well 
tborne. The ordinary formula proves sufficient. 



B. B.39,4, A. B. 38,9 

" " 39,0, " " 38,6 

" 39,4, " " 39,1 

" 39,7, " 39,4 

September- 10th. 

B. B. 39,6, A. B. 39,2 

" " 39,3, " " 39,0 

" " 39,4, 39,2 

" 39,8, " " 39,4 



B. B. 39,6, A. B. 39,4 



" " 39,6, 
" " 40,1, 
" 40,0, 



" 39,4 
" 39,.7 
" 39,7 



B. B. 39,5, A. B. 39,5 

" " 40,0, " " 39.5 

" " 39,9, " " 39,4 

" " 39,7, " 39,4 



September Wth. Tongue a little dry. General condi- 
tion very satisfactory. 



B. B. 39,4, A. B. 39,0 

" " 39,3, " 39,0 

" " 39,2, " " 38,7 

" " 39,3, " " 38,8 



B. B. 39,7, A. B. 39,2 

" " 39,8, " 39,2 

" 39,6, " " 39,1 

" " 39,5, " " 39,: 



September ]2ih. Diarrhoea much diminished, 2 — 'A 
fresh roseolae. Onlv the fever remains. 



—256 — 



B. B. 39,3. A. B. 38,8 

" 39,0, 38,5 

" 39,1, " " 38,6 

39.1. ^' 38.5 



B. B. 39.3. A. B. 38,7 
39,6, 38,9 
39,4, " 38,7 
" " 39,0, " 38,3 
Patient might have skipped two baths, but is ordered 
to coutiuue them even if the temp, is between 38,5 and 39. 

September I3th. Great improvement. Diarrhoea 
increased. Two baths omitted, temp, not reaching 38,5. 



B. B. 38,7, A. B. 38,0 
^. 38.4, — 
" 38,8. 38,1 
" " 38.3. " — 



B. B. 39,2, A. B. 38.1 

39,1, •• 37.8 

- 38,8, 38,0 

" 38.7. 37,8 



Temp, increased upon omission of baths, but not as 
much as in cases of medium gravity. 

September lAith. General condition excellent. Strength 
has returned. Patient continues omitting baths. 

I 



B. B. 39.3, A. B. — 

39,0, *• " 37,8 

" 38,1. " — 

- 38,4. " — 

September loth. 

B. B. 37,7. A. B. — 

38,3, -'^ — 

" 38,8, 38,0 

- 38.3. — 



B, B. 39.3. A. B. 38.6 



38,9, 
^' 38.3, 
" 39,1, 

B. B. 39.0. 

38,4, 
" " 38,9, 
38,3, 



- 38.2 
•* 38,4 

A. B. 38.3 
38.2 



September I6th Patient receives but one more bath. 
The whole treatment having required 50 baths. 

B. B. 38,2. A. B. — B. B. 38.7. A. B. — 

" - 38,4, — " 39,2, ^* " — 

- - 38,3, " — - ^' 39,3, " 38,3 

" '* 38,5, ^' — 37.9. — 



— 257 — 



Senteitiber llth. 38,6—38,5—83,5—38,6—8,73—38,9 

38,7—38,9. 
Appetite lebhaft. Patient asks for food. 
September I8th. 38,2—37,8—38,1—39,0. 
September I9th. 38.2—39,0. 
September 20th. 37,6—38,7. 
September 2lst. 37,8 — 38,3. 

September 22nd. 37.0 — 37,8. From now on to Sep- 
tember 28th the temp, does not reach 38,0 in the evening, 
hence complete apyrexia. 

September 28th. Patient leaves hospital in excellent 
condition. 

In this case there is no stage of reconvales- 
cence. This case lasted only 23 days. Patient 
remained in hospital 20 days. There was no 
combat with fever, defervescence beginning on 
first day of treatment. Still the fever resisted 
somewhat the refrigeration. The great major- 
ity of the mild cases has a more rapid course 
and defervescence is more prompt. This case 
can be looked upon as one between the mild 
form and those of medium gravity. (50 baths 
were given S.j 

Case IV. June 30th 1884. Dr. X. 34 aet, a 
strong man of healthy constitution, felt very unwell, he 
had been attending typhoid fever cases the previous days. 
Chill, loss of appetite, fever and general malaize. These 
symptoms are present all of the following day, towards 
evening increase of fever, further loss of strength. 

July 2nd. Status idem or rather an increase of sever- 
ity of S3'mptoms. 

J \cly 3rd. Patient convinced of having typhoid fever and - 
ahirmed bv the intensity of the initial symptoms, has himself 

17^ 



— 258 — 



admitted as a private patient into the Hotel Dieii. Headac he 
very severe; no photophobia. Pulse regular 112. Meteorism 
and diarrhoea are wanting also borborygmi, T. 40,7. Pat- 
ient has not quite reached the third day of sickness. Diag- 
nosis of typhoid fever not certain but probable. Patient 
himself demands the treatment according to Brand. Tlie first 
bath is given 10 o'clock p. m. (20°, 15 minutes duration.) 
It is borne well, produces however only a very moderate 
reduction. T. 15 minutes later 40,6. The ordinary Brand 
treatment is decided upon, as though the diagnosis were 
absolutely certain. 

July 4:th. The fever is very high and resists refri- 
geration. The morning baths produce no deeper remission 
than the evening baths. Before and after the bath the 
temp, is always above 40. The 16 thermometric conditions 
for the da}^ are the following. 



1a.m. B.B. 40,5, A. B. 40,3 

40,3, 40,1 

40,3, " " 40,1 

40,6, " 40,1 



B, B. 40,5, 
" " 40,7, 
" " 40,8, 
" " 40,5, 



A. B. 40,0 
u u 40,2 
u u 40,4 

^' " 40,1 



The condition of the patient has not changed since 
vesterday. He coughs. Numerous sonorous rales over 
rchest. 

/uly bth. Fever still resists the cooling process. Tlie 
Temp, of the baths are to be from 10 a. m. on lowered to 
18°. The remissions are hardly more noticeable than 
before. 



B. B. 40,3, 
40,4, 

(18°) 40,2, 
40,7, 



A. B. 40,0 
" 40,1 
40,0 
40,1 



B. B. 40,5, A. B. 39,9 



40,5, 
40,6, 
40,5, 



" 40,0 
40,1 
40,1 



Headache very annoying, 
absolutely absent, no tympanites 



Abdominal symptoms 
no diarrhoea. Swal- 



Dwing difficult, nothing but a redening of the pharynx: 



— 259 — 



to be detected. Continuous cough. Numerous sonorous 
rales. Baths of 18° are continued. 

July Qth. The battle Avith the fever persists. The 
temp, before the bath on this day is still above 40, after 
^he bath it sinks to 39,7 once only. 



B. B. 40,4, A. B. 40,0 

40,3, 39,9 

" 40,5, '- 40,1 

u ic 40 4 u u 4Q Q 



B. B. 40,2, A. B. 39,9 
40,5, 40,1 
40,3, " 39,8 

u a 40 2, " 39,7 



Great diminuation of strength. The patient seems to 
be astonished over such an intense typhoid infection. 
•Some delirum at night. Headache always severe, about 
which patient complains a good deal. Cough more plenti- 
ful and harrassing. Muco purulent, thick, glassy expec- 
toration, at times bloody. Auscultation reveals numerous 
sonorous rales mingled with crackling rales on right side. 
Dyspnoea more intense, face somewhat cyanotic. P. 112. 

July 7 th. The same resistance of the fever. In spite 
of the baths of 18° the temp, still remains above 40°. The 
remissions are not more marked than previously. 



B. B. 40,4, A. B. 40,0 

" " 40,0, 39,7 

" " 40,3, " 39,9 

" " 40,2, " 39,8 



B. B. 40,5, A. B. 39,9 
u u 40^4^ u u 40^0 
" " 40,3, 39,9 
" " 40,5, " 40,0 
Status idem. Abnormal symptoms still absent. 
July Sth. The same resistance of the fever during the 
night, from 10 a. m. on the temp, of the baths is to be 15°. 

These baths are not well borne by [not pleasant to] the 
patient but the remissions are more marked after the first 
bath of this kind. 

B. B. 40,3, A. B. 39,8 B. B. 39,9, A. B. 39,2 

a u 40^4^ u u 40^0 " 40,3, 39,5 

" " 40,0, 39,9 " 40,0, " 39,2 

(15°) 40,0, 39,1 40,1, " 39,5 



— 260 — 



Status idem. Baths of 15° contiuued. 

July 9th. The baths are evidently more effectual^ 
w ithout having an}' unfas'orable change in the chest symp- 
toms, the temp, sinks considerably, it has even gone 
down to 39,3 several times before the bath. While in the pre- 
vious days they always remained at the same hight before 
the bath, without a trace of remission, we observe to-day 
for the first time an obvious u.nmistakable morning remis- 
sion. 

B. B. 39,9, A. B. 39,5 i B. B. 39,5, A. B. 39,1 
" 39,4, " " 39,0 ; " 39,4, '' 39,0 
'' " 39,6, " " 38,9 I (20°) 39,7, 39,2 
'' '' 39,3, '' 38,8 i 40,0, '' '' 39,3 

A marked improvement, so that the condition of the 
patient no more calls forth any apprehension. The prev- 
ious severe headache is much diminished. Xo abdominal 
symptoms, no roseola. 

July lOth. The decrease of the fever and the improv- 
ment of the general condition induce us to increase the 
temp, of the baths especially as those of 15° are very 
unpleasant to the patient. Yesterday 10 p. m. a bath of 
20 Avas given as well as throughout July 10th excepting at 
11 p. m. That the fever has been kept down only by the 
energetic and continuous cold-water treatment is more 
evident by the fact that coincidentally with the baths of 
20° on July 10th the fever increased again, so that Ave are 
forced to return to baths of 15° at 11 p. m, 

B. B. 38,3, A. B. 38,9(20)j B. B. 39,4, A. B. 3h,9 
39,5, " " 39,0 '' " 40,4, " " 39,5 

" " 39,3, '' 39,1 I '' 40,6, " " 40,0 

''-40,0, " 39,3 I (15°)40,2, " 39,7 
In spite of the increase in the fever the general con- 
dition has not become worse. 



— 261 — 



July nth. Temp, in the morning still verv high; in 
the evening there is evidently a tendency for it to go down 
Inasmuch as the baths of 15° are burdensome to the pat- 
ient, their temp, is raised to 18° from 8 p. m. on. 



40,0, 
40,2, 
" 39,8, 



" 39,5 
" " 39,7 



39,3 



B. B. 39,5, A. B. 39,0 
" " 39,5, " " 38,6 
(18°) 39,4, " 38,8 
" 39,8, 38,7 



With the rise of the temp, the headache has returned. 
P. 104. No abnormal symptoms. Continuous cough 
•expectoration still bloody, tenacious and slightly tinged 
with blood. 

July 12th. The temp, falls again, more than first 
time, always below 40° before the bath. Baths 18°. 



B. B, 39,7, A. B. 39,0 
" " 39,4, " 38,7 
" " 39,2, 38,8 
" 39,4, " " 38,9 



B, B. 39,3, A. B. 38,8 



39,8, 
39,3, 
39,1, 



" " 39,1 
38,7 
" " 38,6 



General condition improving, 
uvula and veta palati. 



Some thrush and 



July IZth. Temp, sinks slowly but steadily once even 
hQ\o^\ 39°. From 8 a. m. on baths of 20°. 



B. B. 39,3, A. B. 38,7 

39,2, 38,6 

(20°) 39,2, 38,6 

" 39,0, " 38,5 

General condition better, 
iibsent. 



B. B. 38,9, A. B. 38,4 

" " 39,4, " " 38,8 

39,6, " 89,0 

" " 39,2, " " 38,7 

Abdominal symptoms 



Jtfly 14/A. Fever continues its descent slowly })ut 
regularly. 



— 262 — 



B. B. 39,0, A. B. 38,6 

•• " 39,0, - " 38,8 

38,6, 38,2 

" 39,0, " " 37,2 



B. B. 89.9. A. B. 38,6 

- 39,7, - " 38,5 

" " 39,0, 38,5 

" 39.0, ^' 38.4 



Coughs and expectorations present; the latter mucous: 
Avithout admixture of blood. 

Jidy loth. Defervescence completed more and more. 
Temp, in the morning over 38,5 are less in the evening^ 
allowing the first omission of baths. Patient only receives 
three more baths. 

B. B. 38,8, A. B. 38,2 B. B. 38,4, A. B. — 

" 38,6, " " 38,1 " " 38,7, " 38,4 

" 38,3, — ! " 38,3, " — 

" 38,5, — i ^< 38,5, — 

^7^//?/ 16//?. On this day the fever has ceased. Temp, 
once only at 38° Xo. more baths. 37,6 — 37,37 — 7,8 — 33,5 
—37,8—37,9—37,9—37,5. 

General condition excellent. Reconvalescence begins 
to-day. Xo return of fever as shown by thermometrie 
notations. 

Mr. X. remained weak for sorne time, but 
his reconvalescence j^rogressed rapidly. 

This was an incomplete typhoid. The abnor> 
mal symptoms of so much importance for diag- 
nosis were wanting. Xo tympanites, diarrhoea 
nor roseolae were noted. ■ That the disease was^ 
nevertheless typhoid can be proven by the fact 
that four persons, who had taken care of Dr. X. 
of whom two had not come in contact with any 
other patient, were infected from him. These 
had, when his reconvalescence began, typhoid 
fever in a typical form. 



— 263 — 



(3a se V: Marie M. 32 aet, house keeper, admit- 
ted into Hotel Dieu September 9th 1881. Parents tuber- 
culous. Onset of sickness sudden August 18th with severe 
headache and tinnitus aurium. Neither nose bleeding no 
abdominal pain. One evacuation daily, but fluid. Eight 
days later chill, after which cough and dyspnoea. 

Face and extremities cyanotic, breathing frequent,, 
noisy, combined with tracheal rales and dyspnoea so great 
that it was feared that patient might not live to following 
day. Tongue very dry. Abdomen distended but not pain^ 
ful. Old roseolea. No borborygmi. Hearing obtuse. 
Profuse foamy muco-purturbulent expectoration. In both 
lungs, particularly the left, resonant rales, posteriorly, 
behind and below loud bronchial respiration. A^ocal 
fremitus here not diminished; bronchophony and dull- 
ness. Respirator}' rales are so loud that the heart sounds 
cannot be heard. Patient cannot stop breathing on 
account of feeling of oppression. Urine free from albu- 
men. Upon admission, 3 p, m. T. 41,2° — 6 p. m. 41,1°. 

Patient receives at once (22nd day) a bath; after that 
Temp. 39, 4. Temperatures before and after bath until 10 a. 
m. next day: 40,9—39,5; 39,5—38,4; 39,9—39,0; 38,2 
■ — 37,5. Since the first bath the dyspnoea has been greatly 
diminished, and the patient feels a good deal better. 

September lOth. At the visit a marked improvement 
noted with decrease of temp; patient can lie down and 
])reathe freely. Signs of pneumonia on right side still 
])resent. T. rises to 39,5 at 6 p. m. Since all other Temp, 
are only 38,5 and less only a cold enema is given. 

September llth. 10 p. m. Patient feels Avell although 
F, temp, has suddenly gone up to 40. Ausculation reveals 
same condition as on admission. Muco-purulent expecto- 
ration. No alV)umen in urine. Patient is bathed, Temp. 
39—40. 



— 264 — 



September \2th. Temp, is falling; two baths skipped 
Temp, in consequence between 39 and 39,6. The redness 
"of the cheeks is in contrast with the yellowish tinge of the 
face and conjunctivae. Patient answers all questions well 
is delirious at night Cough always present with abund- 
ant expectoration; loud bronchial respiration and numer- 
ous rales. 

September I3ih. Respiration more free in the morn- 
ing; tracheal rales not any more heard at a distance as 
before. Bronchial respiration almost disappeared, patient 
is rarely heard coughing. 0\ er base of both lungs poster- 
iorely moist rales. Expectoration less purulent. Temp 
hardly exceeds 39° in the morning, while it reaches 40 and 
even 40,5 at night. 

September IWi. Temp, varies later between 40,4 and 
39, the latter figure predominating. Patient quiet and 
breathes quietly. \o diarrhoea. 

September loth. T. 39,3 — 40,6. 

September 6th. Marked reduction of T. which is fre- 
quently below 39. Two baths omitted. 

September llth. T. up again .to 40, nevertheless 
improvement continues. Face regains its natural color. 
Patient has slept and feels better. Cough less harassing. 
Over base of right lung some bronchial respiration, rales 
plentiful on both sides. Xo albumen in urine. 

September ISth, 19th, 20th. T. mostly over 39, with 
slight tendency to sinking. Xo albumen in urine 

September 2lst. One bath omitted and September 
22nd two of them. 

September 2Srd. Patient receives but one bath. T. at 
38 in the beginning rises to 39.4 towards evening sinks 
39. 

September 2Ath. T. rises to 40 evenings, baths 
renewed, after that reduction of T. Auscultation reveals 



— 265 — 



the same conditions with diminishing of sonorous rales 
-over base of right lung. Urine contains trace of albumen 
and numerous bacteria. 

September 2f)th. One bath omitted. Similarly three 
on September 26th. Patient complains for some days about 
earache. To-day purulent discharges from both ears. 

September 27th. Two baths. September 28 one bath « 
•only, the last one. 108 baths in 19 days. 

Patient is discharged as late as December 
:20th, has fully recovered some time before and 
enjoys a certain embonpoint. 

When hydriatic treatment was begun in this 
case the condition of the woman seemed despe- 
rate — the dyspnoea was exceedingly great, and 
the Temp, was 41.2; a further very unpleasant 
circumstance was that she had advanced to the 
.20th day of her sickness. From the first baths 
-on, her improvement was palpable, the dyspnoea 
was greatly reducd, and the pneumonia did not 
develop any further; for on the 4th day of the 
treatment the bronchial respiration had almost 
disappeared. This shows that a pneumonia 
occurring in the course of a typhoid fever is 
not necessarally a contra-indication against the 
•cold baths, but on the contrary that pneumonias 
are at times greatly improved by the hydriatic 
treatment. 

Oase VI. An abortive case. Agathe Choz. 23 
aet. Always strong and healthy, chamber-maid on an 
-estate is taken sick after an indisposition of short duration 
August 24 1868 with a rigor, pain in all the limbs, pain 



— 266 — 



in head and nape, tendency to vomiting, no sleep, vertigo, 
red, coated tongne, abdomen distended, P. 120. — Treat- 
ment, calomel 0,5. 

August 26th. Transient improvement after the calo- 
mel. Last night delirinm, to-da}' menstruation begins. P. 
120, T. 40,0. Treatment, calomel. 

August 2^th. Pronounced brain-symptoms, much 
cough, no roseola, spleen enlarged. T. 40,6. P. 146. 
Treatment, bath every three hours. 

August 29th. Symptoms milder, no more brain sym- 
toms. T. 40,0 (three hours after bath) P. 120. 

August 30th. Perspiration during night' T. in the 
morning 86,9. All the symptoms have vanished. Slow 
recovery. Loss of hair. 

This is a case of abortive typhoid, differing from the 
mild typhoid by its shortness, its intensity being severe 
enough. 

Case VII. Typhus levis. Rapid recovery. My 
[Brand] second daughter Anna 12 aet, is taken sick with 
symptoms of a mild indisposition in the country, apparently 
requiring but little attention, after her brother had just 
recovered from a severe attack of typhoid fever. July 9th 
1870 she had a slight chill. August 10th the thermome- 
ter reveals, quite unexpected, a F. temp, of 40,0. In the 
absence of a bath-tub, ablutions and compresses. 

Julg llth. Great dullness, headache, tongue dry, 
coated, abdomen somewhat distended, no passage, spleen 
large, P. between 90 and 100. Great heat and thirst. No 
cough. T. 39,3 — 40,6. Treatment: a bath every three 
hours according to the formula. 

Julg \2th. In consequence of the closeness of the 
weather the effects of the baths are very moderate, although 
hands and feet remain cold from one bath to tlie other. 
Slee})lessness and restlessness, no heavy feeling nor head- 



— 267 — 



ache. Tongue and abdomen the same as yesterday. Much 
pale urine. P. 120. T. over 40,0. 

The chill begins after the bath has lasted 13 minutes. 
Five baths. 15 grains of quinine after midnight. 

July \%ih. Seven baths. Action of quinine good. 
Strong vinous odor from mouth. Little sleep, much sigh- 
ing. Head clear, tongue coated, passages normal a few 
roseolae. P. 100. T. below 40,0. 

July I6th. Excepting the coated tongue, thirst and 
fever, no symptoms. Emaciation marked. . P. 88. Temp, 
gradually declining. Five baths. 

July ISth. Patient feels well. No bath necessary 
last night. P. 82. T. 38,5—39,8. Three baths. 

July 20th. Fever gone. Patient leaves bed. It 
being war time patient is obliged to return home, a rail- 
road journey of 23 hours does not interrupt the good con- 
dition. 

Oeise VIII. H. soldier, sick nine days, in bed 
three days. Headache vertigo, tinnitus, staggering; tongue 
dry, coated, trembling, strong diarrhoea, spleen swollen, 
three rosealae spots. P. 120. T. 40,0. Weight of body 
57,01 kilo, decubitus December 29th, 1870 p. m. day of 
admission and beginning of hydriatic treatment. 

December 30fh, Restless night. Patient in stupid 
condition. Two passages, urine 1300 c c. P. 120. T. 
fallen, 38,7—39,8. Seven baths. 

December St. Moaning and restless during night, 
intellect clearer. Tongue deep red and coated, three pass- 
ages. Urine 3400 c c. P. 92. T. 38,4—39,0. Four 
baths. 

Januarg \st 1871. S3'mptoms improving from day to 
(lay, roseolea dissappears, mild delirium at night. P. 90. 
T. 37,8—39,1. One licpiid passage, urine clearer 5600 c c 
— 4 baths. 



— 268 — 



January 6th. General condition good, appetite 
returning, nights more quiet. — 2 baths. 

After taking now and then a bath of 27° C. he is well 
January 21st. Body-weight on this day 54.8 kil. When 
discharged 62.7 kil, which is 5,6 kil more than at admis- 
sion. 

These mild cases are conimimicated in 
extenso, so that those who treat such cases with 
medicines may compare the course under the 
different forms of treatment. 

I think it can be assumed that under indif- 
ferent treatment the duration of the disease 
would have lasted at least a number of weeks 
and even if the patient had recovered the after- 
effects would have shown themselves for weeks. 

Here the symptoms which were not at all 
mild disappeared within the first 3 — 4 days of 
treatment, and the feeling of being sick vanishes 
from the patient as soon as the fever has gone 
•down, and even before, the patients are able to 
go out of doors and their strength is preserved 
in a remarkable way. That a reconvalescent 
from typhoid fever, four days after the decline 
of the fever should make a rail-road journey 
of 23 hours, without suffering any bad eft'ects 
from this undertaking, is not apt to be possi- 
ble or advisable after medical or indifferent 
treatment. 

Case IX. R. soldier, 28 aet. Sick 19 days. 
Besides the ordinary symptoms of typhoid fever, hoarseness 



— 269 — 



and strongly developed bronchial catarrh are present. T.. 
in the first 24 hours, without baths 39,1—39,7. P. 100. 
Urine 700 c c, turbid, three passages. 

January 3l6-^, 1871. Beginning of hydriatic treat- 
ment. 

February 1st, Tongue dry and red, two liquid stools, 
much moaning and coughing. Marked chill after bath^ 
P. 94. T. 38,9—39,6. Urine 1800, dark— five baths. 

February ?>rd. Great Aveakness, less cough. P. 84. 
T. 38,7—39,6. Urine 2600, somewhat clearer.— four 
baths. 

February 6th. Condition satisfactory, good sleep, 
cough and moaning less. P. 88. T. 38,8—39,5. Urine 
1500 c c, still dark — five baths. 

February 1th. No complaints, only hoarseness and 
hardness of hearing. . P. 94. T. 38,6—39,4, urine 1800— 
two baths. 

February ^)th. G-ood condition, excepting hoarseness 
and hardness of hearing. Patient died during after-dinner 
sleep, without his neighbor noticing it. 

Post mortem examination revealed typhoid ulcers, 
almost healed and fatty degeneration of the heart. 

Oo-se X. Grave typhoid, rapid development, recov- 
ery. My (Brand's) oldest son Ernest, 15 aet, of the corps 
of cadets in Berlin, does not present during the Whitsun- 
tide vacation his usual liveliness. He is tired, sleepy, 
quiet, has no appetite and a coated tongue: On the day of 
his intended departure, (June 6th 1870,) he declares him- 
self unable to get out of bed, complaiuvS of feeling sick, 
and of liaving had a chill. T. 39,5. P. 100, at noon T. 
39,3. P. 100. In the afternoon he complains of numb- 
ness in liands and feet, nausea and pain in the stomach. 
Upon examination two lumbar and two thoracic vertebrae 



— 270 — 



-are found to l>e tender, liver swollen. At 4 p. ra. T. 40,1. 
P. 94, at 10 p. m. 40,1.— Baths. 

June Sth. Restlessness, delirium and moaning during- 
night. Head clearer to-day, tenderness of liver and verte- 
brae less, tongue more moist. From Berlin the report 
arrives that besides my son a number of cadets have been 
taken down with typhoid fever. T. 39,0—40,3. P. 92— 
six baths. 

June 9th. Xight passable, restlessness, delirium 
diminished, less pain, urine pale, but in small amount, T. 
39^2—40,2. P. 96,— five baths. 

Jujie nth. Condition satisfactory, intellect clear, all 
pain and the feeling of numbness have disappeared. 

Asks for frequent baths, asserting that the hotter the 
b)ody, the more unpleasant the baths. After sleeping the 
cheeks are red and hot. A good deal of sleep between the 
baths. Roseola absent, spleen much enlarged. T. 38,3 — 
40,5. P. 84—100. Very irritable.— eight baths. 

June V2th. The symptoms of typhoid disappear one 
5\fter the other, tongue moist, appetite lively, no belching, 
one semi solid passage, a great deal of sleep, a large 
^amount of pale urine, the chill after the bath moderate. T. 
^9 — 40. P. 84, — six baths, the effect of the bath good. 
(20 C.) 

June ISth. Two roseolae, patient no more alarmed 
Avhen aroused srom sleep, as heretofore, strength returns. 
T. 39,0—40,4. P. 88,— eight baths. 

June I4:th. Condition satisfactory; appetite accute. T. 
37,8—39,9. P. 88,— five baths. 

June I6th. The experiment to allow the patient to 
sleep longer at night, has unsatisfactory result. T. 40 and 
bad general condition. Passages solid. T. 38,7 — 40,0. 
P. 78. A great quantity of pale urine. — six baths. 



— 271 — 



June nth. Condition satisfacsry; patient occujfies 
himself killing flies. T. 37,5—39,3. P. 92,— five baths. 

June I9th. No complaints excepting hunger. T. 
38,3—39,0. P. 80,— four baths of ^8° ten minutes dura- 
tion. 

June Vlnd, T. normal. Patient gets up. 

(See plate V. Fig. I.) The case is noteable 
on account of high temperature not often observed 
on the first day. A regular ascent does not take 
place no more than the febris continua during 
the second week; towards the end of which a 
tendency to an intermittent type is observed. 

The temperature has the tendency to rise 
after each bath to its original hight. From the 
fourth day on, the force of the fever is broken, 
it reaches 40° only at a certain time, when a 
mistake in the treatment has occurred, that is 
when the patient has been allowed to sleep to 
long. The highest points of the curve there- 
fore are to be found near midnight, The anti- 
pyretic effect of the baths increases after the 
fourth day. 

Even on the eighth day the period of remis- 
sions are of longer duration and a smaller num- 
ber of baths is required. On the 15th day the 
fever has disappeared without any accidents. 

These two observations illustrate some of my 
propositions (Brand) with rare completeness. 

As is well known Liberman, Wunderlich, 
and many others (Pepper's system) demand that 



._ 272 



the water treatment should be reserved for the- 
grave cases and that the milder casas should b3 
treated with medicines or indifferently. 

Well the first one of these two cases is cer- 
tainly a mild case and ends fatally, although 
by the water treatment all febrile symptoms have 
been made to disappear. The man is feeling as 
well as he can, when death suddenly supervenes. 
All the symptoms are moderate, the temperature 
relatively low, and yet fatty degeneration of the 
heart has been developing, causing instantane- 
ous death. 

Hence it follows, that it is a mistake to look 
upon typhoid fever with mild symptoms with 
indifference. 

The sudden death did not come quite unex- 
pected. 

The small amount of urine and its dark 
color are always a sign that somethiifg abnormal 
is in progress in the system of the typhoid fever 
patient, that something unexpected may turn up. 
What it may be, is hidden often enough. Never- 
theless the sign is useful because it demands 
carefulness and may prevent surprises. 

A pendant for the first observation is the 
second. Here the disease develops rapidly with 
symptoms, Avhich make a grave case probable 
and which call for an unfavorable prognosis. ' 



— 273 — 



The local disturbances of the stomach and 
liver, the intense afiection of the brain, the par- 
ticipation of the spinal cord, the rapidly increas- 
ing weakness (on the evening of the first day the 
patient could neither stand nor walk) the high 
temperature — all these symptoms even on the 
first day pointed to the fact, that the infection 
must have been an intense one, that the poison 
in all probability had entered by the stomach 
and that the patient would have hardly lived to 
the ninth day under indifferent treatment. As 
a matter of fact 25 per cent of the cadets that 
were taken sick died. 

The water-treatment conducted by myself 
the father, in this case had a brilliant effect. 
Notwithstanding the intense development of 
the symptoms everything took its course just 
as it should have done and as it had to do; not for 
a moment did care or anxiety weigh down my 
spirits after the diagnosis was certain and the 
treatment had been instituted. The boy did not 
only recover but developed into a stronger man 
than I had ever dared to hope. 

Case XI. Madame R., 28 aet, blond, good 
physique, allways healthy. Ill ten days, roseola and 
enlarged spleen. 

June Sth, 1872. T. always over 40°, insomnia, deli- 
rium, cannot remember an^^thing, hard of hearing, two* 
liquid passages passed involuntarily, tongue dr}^ P. 96 — 
baths. 

18 



— 274 — 



June lOth. Fever under control, T. 38,1—40, P. 120, 
quiet sleep, consciousness clearer, much pale urine — seven 
baths. 

Jime 12th, Patient sleeps and rests quietly, diarrhoea 
diniinished, — five baths. 

June IZth, P. 120. T. 38,2—89,5, angina and 
aphthous patches in mouth, — six baths, chlorate potass for 
gargling. 

June P. 110, T. 38,3—39,8, some cough, swell- 

ing of lymphatic glands of neck, sensorium clear, passages 
solid, one furuncle, — five baths. 

June loth. P. 125, condition quite good, hardness 
of hearing and weakness of memory still present. T. 38,2 
— 39 j6, much pale urine, — four baths. 

June nth. P. 120, T. 38,5—39,6, condition satisfac- 
tory, great irritability, good appetite, wants to get up. — 
six baths. 

June 20th. P. 100, T. 38,1—39,5, much cough, 
pain in larynx, pain in toes, urine abundant and clear — 
four baths. 

Ju?ie 22nd. P. 110, T. 38,2—39,6, angina, lymphatic 
glands swollen, pain in larynx has disappeared, great appe- 
tite and impatience — three baths, two grains quinine. 

June 22>rd. The action of the quinine good, P. 96, T. 
38,0 — 39,4, everything normal aside from the deafness, 
several furuncles, gets out of bed and spends an hour in 
the garden. — Last bath June 24th. Prespiration. July 
6th complete recovery, hearing perfect. 

This lady lives at a distance of 30 (German miles) 
from here. Summoned by telegraph I find besides her a 
sister 16 years of age in a dying condition. I make an 
effort to save her, and I am able to recall her to conscious- 
ness, but after some time she succumbs to the fever. Aside 
from this patient the family had lost four grown children 



— 275 — 



from typhoid fever. A fifth one, a 3'"oung man of 21 dies 
a year later from typhoid fever in a hospital here. Out of 
the seven children, which have been attacked by the 
typhoid fever, the one only treated with water by myself 
survived. 

See plate V., Fig. II. The combat with the 
fever, although the case was a grave one, lasts 
but two days. From the third day on the effect 
of the baths increases and after the fourth day 
the average temperature sinks to below 39. Com- 
plete deffervesence on the 27th day oE sickness. 

Case XII. Grave typhoid, severe brain affec- 
tion, persistent diarrhoea, curious behaviour of pulse, 
recovery. 

Miss F. BO aet, always healthy, of irritable temper- 
ment. Prolonged prodromi, chill July 5th 1868, took to 
her bed July 6th, when delirium and unconsciousness 
began. On the 8th a dose of castor oil produces diarrhoea. 
Under other treatment until the evening ot ihe 11th when 
the water treatment was begun. Complete unconcious- 
ness, loud delirium, makes strong efforts to get out of bed. 
Has not slept since beginning of sickness. Covered with 
perspiration, hands and feet cold. Face dark red. Mouth 
closed spasmodically. Spleen enlarged. Roseola. Invol- 
untary discharges. P. 120. Patient is so restless, that the 
thermometer cannot be used to ascertain the temperature. 
Menses present. In the first bath 18°C. (65 F.) and affu- 
sions of 10°C. (50°F.) and ten minutes duration, conscious- 
ness does not return, skin is reddened. One hour after the 
third bath, 10 p. m. T. 37,5. 

July 12th. Night poor, no sleep, extreme restless- 
ness. Measurements impossible. At 10 a. m. conscious- 
has returned. Patient recognizes me. Face rather pale 



— 276 — 



than red. Tongue red, coated, dry. Xo perspiration^ 
hearing affected. Patient quiet, slight cough. P. 100 
Urine dark and scanty. T. 38,0 — 40,1. — Seven baths. 

July iSth. Great restlessness, delirium continues. 
P. 84—96. T. 39,4— 40,2.— Seven baths— one dose 0,02. 
grm grain) morphine. Seven hours sleep after the 
morphine, restlessness much diminished, intellect 
clearer. 

July I4:th. Obtuseness of hearing very marked, tre- 
mor, difficult speech, diarrhoea profuse, no longer in bed. 
P. 88. T.38,8— 40,8,— six baths. 

July Ibih. Brain-symptoms are disappearing, 
higher. 16 — 18 passages in 24 hours. After sleeping the 
T. always higher; patient therefore is ordered to be awak- 
ened for her bath. P. 94. T. 38,4— 40,5— eight baths. 

July llth. Tongue cleans off, moist, 26 evacuations 
Pain in heels. Urine pale, P. 112, T. 37,6— 39,6,— six 
ba^hs. Starch enema with opium. 

July ISth. Fewer evacuations. Sugillation on legs.. 
Slight furunculosis on chest and back. General condition 
good. P. 100, T. 38,0— 40,2,— four baths. 

July I9th. Much quiet sleep, T. 38,3 — 40,2, the 
high temperatures always after the sleep, — five baths. 

July 20th,. Diarrhoea continues three times a day 
nevertheless much pale urine. Face collapsed, P. 120, T. 
37^4—40/2,— five baths. 

July 2lth. Seven evacuations, urine abundant of 
light color. Hunger! Furuncles healing: Pain in both 
heels. P. 112, T. 38,3— 40,1— four baths. Wine every 
3 hours, friction of heels with alcohol. 

July 22nd. Too much excited from the Avine, it is 
omitted. P. 100, T 37,7— 39,4,— five baths. 

July 24^/i. Sugillation spots on both arms, both 
nates red. Eleven evacuations, tongue red, tympanites 



— 277 — 



very moderate. Sleep good, P. 112, T. 37,8— 39,1— three 
baths, a pill containing: Tannin, Ext. Nuc. Vom. — Opium 
to combat the diarrhoea. 

July 27th. Two passages. Furuncles and sugillations 
have dissappeared. Patient feels well. P. 112, T. 37 — 
39,7, — two baths. 

July 2Sth Patient gets up. Transient exacerba- 
tions of fever, probably due to eating too much — Bi-carb. 
soda. 

July SOth. Feels perfectly well, sleeps much, gains 
strength. No evacuation, urine abundant. P. 128, T. 
37,7— 39,0,— last bath. 

August Srd. Complete recovery. 
As can be seen, baths of moderate tempera- 
ture were sufficient to reduce the high fever even 
though perhaps a day more may have been 
required, than if colder proceedures had been 
employed. The sweating present in the first 
days did not prevent the employment of the 
baths, nor did the presence of the menses. The 
obstinate continuation of the diarrhoea 
under the hydriatic treatment is a rare occur- 
Tence. Amongst all my cases there are two 
only which needed special attention on this 
account. The high temperature in the middle 
and near the end of the disease can be explai- 
ned by faults in the nursing. The patient Vv^as 
allowed to sleep to long, and to eat too much. 
Contrary to the rule the brain was not quieted 
by baths alone and morphine had to be 
made use of. 



— 278 — 



Case XIII. Grave typhoid, clonic and tonic- 
convulsions. Recovery. Erich H., 2 aet, parents healthy 
was taken sick during the prevailing epidemic 2 J weeks 
ago, with gastric symptoms, restlessness, sleeplessness^ 
high fever. After some days there were added to these 
symptoms during an evening exacerbation convulsions im 
the back part of neck and twitchings of hands lasting 
15 minutes and ceasing after the appearance of nose bleed- 
ing to return soon in frequency, spreading over the whole 
body and continuing for several days and nights. High 
fever and burning skin, P. 130. Child is lying on his 
back with eyes open and rolled upward, unconcious, 
unable to hear, the expression is wasted, face pale except- 
ing during exacerbations, when it is red. The nape of the 
neck is rigid, convulsive movements all over body, abdo- 
men distended, tendency to diarrhoea, involuntary evac- 
uations. In this condition the little patient has been night 
and day and has not closed his eyes to sleep since the 
beginning of the sickness. Xo medicine have been of any 
avail to produce any amelsoration. Treatments: A warm, 
full-bath of ten minutes duration of 35° (95 F.) with affu-- 
sions of 20° ( 68 F. ) every four hours, compresses etc. 

December I8th. (19 | 1.) Sleep of short duration 
with half closed eyes; exacerbations lee^ severe, twitchings 
only now and then. P. 120. 

December 2lsi. (22 | 4.) Consciouness and hearing- 
present, the stiffness of the nape of the neck has disap- 
peared, convulsions weak, and short. Eyes closed during 
sleep, keeping right direction during waking. Signs 
of returning power of of self-control. Xo passages. P. 96. 
Treatment: Four baths daily, nutritive diet, enema. 

December 3rd. (24 | 6.) Convulsions rare and insig-- 
nificant. Good appetite. 



— 279 — 



December 2bth. (26 | 4j Beginning of recovery. 
Since yesterday no convulsions. Treatment: Three half- 
baths of 27° (80 F.) five minutes, compresses, nutritious 
diet. 

January lOih 1859. (42 | 24) Complete recovery. 
The hair finally came out and the child, according to the 
fathers statement, has grown strong and healthy. 

Oa.se XIV. Mrs. W. 25 aet. Small and delicate, 
mother of a child 14 months of age. Chronic bronchitis 
and pneumonia, upper left lung. Tendency to fainting 
spells and rheumatism. Does not know that she is preg- 
nant three months. 

The typhoid fever begins with marked feverish attacks 
followed by intermissions, after that continuous high 
fever. 

January 6th. She is unable to leave her bed. T. 
three hours after the bath always 40—41,4°. (104—107 F.) 

On the 14th day severe abdominal pains, which create 
the suspicion ot peritonitis. On this account, and because 
the family physician is not successful in reducing the fever 
sufficiently, my advice is sought. 15th day. Patient has 
aborted while in bath, without being aware of it. Pains 
have ceased. After using baths of 16° (61 F.) and 15 min- 
utes duration the temp, rises to 40° (104) only after 4 — 5 
hours. 

22nd day. General condition excellent. Lochiae reg- 
ular, high temp, continues. The baths to last twenty 
minutes. 

29th day. Lochiae have ceased. Appetite voracious. 
Patient refuses to be bathed, asserting that she will suffo- 
cate in the bath. The husband enforces the bathing; pati- 
eijt does not suffocate, (simulation.) 

35th day. The high temperatures cease. Patient 
does not object to bathing but prefers cooler and shorter 
baths. 



— 280 — 



42nd day. Patient leaves her bed. and although 
always conscious, she does not remember anything out of 
the last weeks. Promenades in room without support. 

52nd day. After five days of complete health the 
temp, rises again, gastric symptoms make their appearance 
vomiting, diarrhoea, sleeplessness, tympanites, acute pain 
in left hip joint and right shoulder. The excessive pain 
upon being moved, enforces the omission of the baths. — 
Quinine 1.5 grm. (23 grains i to be taken in one dose 
at night. 

53rd day. Quinine without any effect. Sleeplessness 
intellect clouded, delirum. subsultu? tendinum. involuntary 
evacuations. P. 110. T. continually over 40^. 

55th day. The case begins to look very serious. Com- 
plete unconsciousness, subsultus delirium. P. 120 very 
small. T. 40.3 — 40.6. Gangrenous decubitus OA'er troch- 
miters and heels. Quinine in 2 grm. doses, inefficacious. 
Treatment: TThen temp, reaches 40^ a gradually cooled 
down full bath. 

59th day. Improvement apparent. Pain dissappeared 
in bath. 

61st day. Patient feels completely well. Slow recon- 

valescence on account of the numerous bed-sores. 

The perusal of the history of this case is to 
be recommended to those opponents of the water 
treatment; wlio prefer quinine to the bath. 

Certainly this question is pertinent: AVould 
this patient have been saved by medicines? I 
answer with a decided no. A continuous high 
fever of the character before us is not compat- 
able with life,, and quinine failing to come to 
our aid, its suppression was simply impossible. 



— 281 — 



The case teaches that a chronic pneumonia 
(phthisis) or chronic bronchitis does not grow 
worse under hydriatic treatment. 

The case demonstrates further that an abor- 
tion and the puerperal state take a normal 
course under strict hydriatic treatment (baths of 
16°, twenty minutes duration in a room of 20°.) 

The case shows also, that the temp, can 
always be reduced, if the necessary energy is not 
wanting, and that quinine is not necessary for 
that purpose. The patient had received up to 
my appearance on the scene, luke-warm half- 
baths with cold affusions, too warm and of too 
short duration to produce the necessary reduc- 
tion of temperature. The cold baths of 16° and 
twenty minutes duration very promptly brought 
down the temp 2°. 

It is interesting to observe the efforts of the 
patient to free herself from further bathing by 
simulating suffocation in the bath. The same 
mental attitude is not unfrequently found in the 
case of honorable colleagues, suffering from ty- 
phoid fever, they ask that the temperature be 
taken in the mouth and clandestinely manage to 
bring the bulb of the instrument on the upper 
surface of the tongue instead of beneath it in 
order to present a temperature which will 
not require a bath. I know of two such 
cases. 



— 282 — 



The preservation of the strength in spite of 
the long diircxtion of the fever (41 days) must 
excite admiration. On the very first day after 
the patient was out of bed, she felt, as she 
expressed herself, strong enough to dance. 

Very instructive is the condition during the 
relapse. As long as the hydriatic treatment 
was carried out the condition of the patient 
leaves but little to be desired. The baths have 
not been omitted more than 24 hours, when the 
complete typhoid fever picture presents itself 
and the symptoms indicating a grave condition; 
gangrenous bed-sores appearing on the third 
day. 

When necessity — in spite of the pain — did 
enforce the resumption of the baths, not only 
the pain but all the symptoms of typhoid fever 
vanish in four days. 

Evidently the omission of the baths was a 
mistake which almost cost the life of the patient. 
Others may derive benefit by this confession of 
mine. I, for my part, shall be careful not to 
interrupt the water-treatment in a case of typh- 
oid fever hereafter on account of rheumatism or 
any other complication. 

That menstruation, pregnancy, abortion, 
the puerperal state do not forbid the water- 
treatment, on this point there is universal con- 
sent. 



— 283 — 



(3a se XV. Grave typhoid, chronic bronchitis and 
emphysema. Wendt, 32 aet, has been [on account of 
of bronchitis and emphyema] in the hospital for some 
time. Six days ago he reports as worse, complains about 
chilliness and heat, stich in side and oppression in breath- 
ing. Condition is looked upon as an exacerbation of the 
old trouble; dullness, bronchial respiration etc, not to be 
detected. In the night from February 2 — 3 he begins to 
grow delirious. Examination reveals a red, coated tongue, 
slight tympanites, enlarged spleen, borborygmi, rales over 
whole chest, hot head, injected conjunctivae, P. 94, T. 
39,5. Body-weight 135 lb., 9 oz. Beginning of treatment 
after formula 5 p. m. compresses. 

February Uh, The baths do the patient good, 
although he coughs much in and after the baths. Between 
the baths much sleep. Delirium at night. 

Head clearer after the baths. One liquid stool, urine- 
300 cc. P. 94 T. 37,7—40,2—7 baths. 

February 6th. Much moaning and delirium; cough 
and expectoration abundant; one liquid stool daily, urine 
400, dark. P. 120, T. 38,2—39,9—7 baths. 

February 8th. Head clearer, less delirium, more sleep. 
Chest symptoms the same, no oppression. Coarse and fine 
rales as previously. Much cough during bath. One pass- 
age. Urine 1900, of lighter color P. 112. T. 37,8—39,7 
— 7 baths. 

February lOth. Tongue grows moist, less red. Head 
quite clear, some moaning during sleep. Rales diminished 
over chest. Same as before the attack of typhoid. Urine 
2000. One passage. P. 1 20. T. 37,5— 394— 6 baths. 

February \2ih. Cough variable, at times more, at 
times less. Expectoration diminishing. Fever ceases 
Two passages. Urine 1900. P. 94. T. 37,9—39,4—2 
baths. 



— 284 — 



February l^th. Temperature does not reach 39 since 
yesterday. Head clear, tongue moist, appetite. Chest 
symptoms mild. Urine 2900, clear as water. Three pass- 
agrs. P. 78. T. 37,5—38,5. No baths. 

February 20th. Patient gets up to leave hospital, 
March 15th with a mild bronchial catarrh and a body- 
weighi of 87,85 kilo. 

This observation shows that the existing 
catarrh is not only not made worse by the water- 
treatment, but that its increase due to the typhoid 
infection is diminished. After the disease has 
taken its course, the bronchial catarrh is even 
less than before. 

(3a.se XVI. To present a picture of the difficulties, 
with which I [Brand] had to contend during this epidemic 
[1877] and to show at the same time the power which the 
water-treatment places in the hands of the physician, I 
take the liberty to narrate the following episode recom- 
mending the perusal of the same to the opponents of the 
water-treatment: 

B. Clerk, 21 aet, living with his parents one mile from 
Stettin, but working during the day in an office situated in 
the typhoid-fever-district, Avas taken sick July 29th. Aug- 
ust 28th the oldest sister, August 31st the two youngest 
children, September 4th the father, September 5th the 
mother and September 7th an aunt are taken down also 
with typhoid fever. Thus seven of the nine members of 
the family are down with typhoid fever at the same time. 
One son only, attending school, and a daughter of about 18 
years are spared. 

As a matter of course the house-hold aftairs come 
almost to a stand-still, none of the relatives venturing to 
enter the typhoid-fever-nest, and the spirits of the afflicted 
persons are tlms greatly depressed. 



— 285 — 



The two youngest children have the disease in a mild 
form (duration of fever 11 days) the disease of the aunt is 
of medium duration, (21 days,) of a severer form is the case 
of the mother, (27 days,) and the father (36 days,) quite 
grave the case of the oldest daughter (48 days.) The lat- 
ter is chlorotic and in a low state of health, when attacked 
by the typhoid fever, which takes its cource as a continu- 
ous fever with high temperatures. The effects of the qui- 
nine and the baths are not what one might wish for. For 
21 days a bath of 15° (59 F.) has to be given every three 
hours, night and day. On the 22nd day hysterical convul- 
sions and an attack of syncope make their appearance, the 
temperature remaining high. The patient absolutely refuses 
to be bathed any further and has to be compelled by myself 
to do so. While parleying the temperature has risen to 
41,5° (107 F.) On the 25th day retention of urine and 
vesical spasm. On the 30th day bronchitis and pleuritic 
pains. On the 31st day quinine calls forth severe stomach 
ache and vomiting lasting three days, in consequence 
extreme weakness, uncountable pulse etc. The attendants 
give up all hope for recovery, the nurses refuse the 
continuation of the baths and prefer to pray. It requires 
all of my authority to have them go on with the treatment. 
Disappearance of the fever on the 48th day. During con- 
valescence the patient has an attack of sciatica. On the 
Y2nd day the young lady, who according to all appearances 
had been doomed to die, is found sitting at the piano and 
playing in her customary perfect manner. Perfect recovery 
(sciatica included) November 7th. 

What would have been the fate of this fam- 
ily without the water-treatment? 

Case XVII. B. Dr. Juris, 26 aet., was not to be 
subjected to hydratic treatment on account of ^ 'heart dis- 
ease." When intestinal hemorrhage supervened, I was called 



— 286 — 



in consultation. Nothing but hydropathic treatment would 
meet the case. I therefore recommended in spite of heart 
disease and hemorrhage, the formula which was carried 
out with all thoroughness and which, instead of collapse 
and renewed hemorrhage, as was feared, brought about a 
good condition of the patient and rapid recoTery. 

Oa.se XVIII. In the cases of the glove-maker W., 
over 30 years of age and intemperate, the water- treatment 
was to be omitted on account of the weak heart. I found him 
in a very low condition, Avith a small, miserable pulse of 
over 140, unconscious, the lungs filled with mucus. The 
half-bath with cold affusions brought about such a profound 
change, that after a few days the visits on my part 
became unnecessary and the patient made a good recov- 
ery. 

(These two cases were added to show how 
rare cases must be which form justifiable contra- 
indications to the method. S.) 

C-ase XIX. On the estate K. in the neighborhood, 
there occurred in rapid succession sixty-four cases of ty- 
phoid fever in a population numbering 123 persons. It 
seemed impossible to use the water-treatment in this 
instance. Dr. Q., however, removed all the difficulties by 
changing an old chapel into a hospital, placing the men 
on one side, the women on the other, a curtain was drawn 
through the middle, sisters (diakoaissinnen) took charge of 
the nursing and not a single patient died. One of the cases, 
the wife of the proprietor of the estate, was treated by 
myself. The young woman was pregnant, suffering from 
vomiting, and had the whooping cough. In spite of preg- 
nancy, vomiting, whooping cough and typhoid, which 
combination might have kept back from employing it, the 
hydriatic treatment was carried out systematically, abor- 
tion did not take place and the patient recovered. 



— 287 — 



(Here we learn how difficulties may be over 
come, illustrating the old adage that where there 
is a will there is a way. S.) 

C3a.se XX. Has more than scientific interest. To 
mention another obstacle for the cold-water troatment, 
which perhaps is the most frequent one — poverty — I shall 
narrate the following episode which is the most touching I 
have ever experienced. July 14th 1875, I, [Brand,] was 
called to the narrowest street in Stettin, fourth story, to 
see a sick child, six years of age, evidently suffering from 
a severe attack of typhoid fever. An old, deaf, crippled 
grandmother, next a weak but intelligent looking boy of 
eleven years, and a sister of the same type, twelve years 
old, were the attendants of the patient, the parents being 
absent from home, engaged in earning the daily bread. I. 
informed the children of the nature of the malhdj and 
requested that the sister should be brought to the chil- 
dren's hospital, inasmuch as the parents, who had to pro- 
vide for the maintenance of the family, could not under- 
take the nursing of the child, and the habitation — one 
room and one dark sleeping apartment for six persons — 
seemed not very well adapted for a sick room. 

The eleven year old boy declared with a firmness 
which called forth my admiration, that his sister should 
not under any circumstances be removed to the hospital; 
he, the little fellow, was desirous that she should be trea- 
ted with water, and for no other reason than that had they 
called in me and not some one else. The situation amused 
me; but I had to call the boys attention to the difiiculties 
of the nursing, the taking of the temperature, the bathing, 
etc. ''All this makes no differenc," was the answer, ''only 
show us what my sister and I have to do, and you shall be 
satisfied with us." And indeed I was satisfied. Never 
was there a child better taken care of, than this 



— 288 — 

child of a laborer, by bis eleven and twelve year old bro- 
ther and sister. Regularly she was bathed, the tempera- 
ture taken, nourishment given, the record kept, day and 
night. For two weeks the little man did not get out of his 
clothes. Unfortunately at the end of July the sister, who 
had faithfully assisted in the nursing, was taken sick, with 
temperature of 41 C. (105,8 F.) He thus had to take care 
of two patients. And now there occurred what perhaps 
has not happened before, that when he was taken sick 
himself, August 8th with an evening temperature of 40 C. 
(104 F.) he did not go to bed but continued bathing him- 
self and his two sisters every three hours, and only laid 
down to rest at night between the baths. Happily in his 
case, the disease took a mild form. August 20th he was 
free from the fever, the other two patients August 25th. 
The little hero's name — it seems not out of place to men- 
tion it — is Franz Witte, and he now is a composer in the 
the printing establishment of Redei. The records of the 
cases, which he kept, I have preserved as a souvenir. 

(I have inclosed this history in this essay, 
not only for its intrinsic interest but for ]3racti- 
cal reasons. I think by relating it to some of 
our patients (and to ourselves) when the difficul- 
ties seem very great, it may help to strengthen 
— so to speak — their moral backbone and encour- 
age them to undertake things which rarely will 
involve difficulties as great as this eleven year 
old boy had to overcome. On the other hand, 
there is no doubt that if we had, or once shall 
have, the public in the condition of mind in 
which the boy was, we shall have the most of 
the difficulties of the water- treatment overcome ,v 



~ 289 — 



for where there is a will there generally is a 
way. 

Just by way of contrast let the reader, if he 
has time, take down ^'Pepper's System," and 
look at some of the objections he will find there 
enumerated. It strikes me that while the young 
German boy acted like a man the American sys- 
tem talks like a child. S.) 

Case XXI. Gravest typhoid. Convulsions. Re- 
covery. Shoemaker Clich, 34 aet, blond, of small stature, 
has just removed from the country to the city, where an 
epidemic of typhoid fever is prevailing, and is soon infec- 
ted. Toward the end of November he suffers from general 
ill health, followed by diarrhoea, fever and delirium, 
w^iich at night are of a noisy character. In one such attack 
the patient pours while out of bed four pails of cold water 
over his head and as this proceedure is pleasant to him it 
is difficult to stop him in carrying it out. The physician 
Avho has been attending him is able to make the diagno- 
sis of typhoid fever from the swollen spleen and the roseola. 
Called on the 8th day to apply the hydriatic treatment, I 
find the patient in a very precarious condition. Concious- 
ness as well as hearing and seeing have almost dissap- 
peared, speech slow and difficult, a typhoid expression of 
countenance, pale face, dark red during the exacerbations. 
Dorsal decubitus, extreme muscular weakness, subsultus 
tendinum. Has not slept a wink since the beginning of 
his illness. Abdomen greatly distended, spleen enlarged 
no roseola, constipation. Skin burning hot^ P. 150. 
uncountable during exacerbation. — Treatment: half-bath 
of 27° C. (80° F.) affusions of 10° C. (61° F.) com- 
presses. 

19 



— 290 — 



December lih. (9 | 1 day.) The bath is not fol- 
lowed by rest and sleep; on the contrary the synaptoms 
have increased. 

Convulsions continue, trismus, subsultus, deepest stu- 
por, greatest restlessness, pulse uncountable, life in 
imminent danger. — Treatment; Warm full-bath of 35° C. 
(95° F.) affusions of 30° C. (86° F.) gradually down to 20° 
C. (68° F.) to last as long as possible and to be repeated 
three times a d?Lj, compresses etc. 

December Sth. (10 | 2 day. This form of bath pro- 
duces excellent results: sleep and rest have set in, the con- 
vulsions have ceased altogether, subsultus is diminished, 
temperature less, skin duftend. Urine is passed in large 
quantities. P. 100. — Treatment continued. 

Dvcember dth. (H | 3 day.) Improvement sets in: 
Brain and nervous system quiet; consciousness clear; dur- 
ing the night quiet sleep lasting several hours, no subsul- 
tus. T. moderate, skin duftend] exacerbation pronounced 
only towards evening, pulse 88. Vesicles filled with pus 
appear all over the body. — Treatment continued. 

December \2th. (14 | 6) day.) Subjective condition 
good, the baths refresh and invigorate the patient. Con- 
sciousness clear, no trace of convulsions. Tongue clean 
and moist, abdomen flat and painless, passages only when 
an enema is used, no more involuntary. — No perspiration, 
skin duftend. Urine excreted in large amount. Body lit- 
erally covered with ekthyma-pustules, between which a 
number of furuncles appear.— Treatment: Two baths 
daily and nourishing diet. 

December 20th. (22 | 14) Pustules decrease and 
fufuncles increase in number; but for their presence the 
patient would be able to be about. Patient is gaining. 
Fever insignificant.— Treatment One bath daily with 
affusions; no cottipfesses— very nourishing diet, beer. 



January 1st 1859. (32 | 25 day.) Fifty fiirimcieg 
have made their appearance and enormous quantities of 
pus have escaped. New abscesses rarer. — Patient gets up. 

Oase XXII. Grave typhoid. Intestinal hem- 
orrhage. Recovery. 

Lindenberg, paper-hanger, 23 aet. Thin but always 
healthy, after a period of general ill-health was taken 
down during the epidemic of typhoid fever January l7th 
1859 with a heavy chill, but manages to keep on his feet 
by shear force until the 20th when, after an emetic, great 
weakness, high fever and delirium having set in, and he is 
persuaded to stay in bed. January 23rd severe nose-bleed 
occurs prostrating the patient more, and on the evening of 
that day I am called to apply hydriatic treatment. 

Status praesens: Eyes wide open, stupid expression 
of the pale, collapsed face; unconsciousness. He does not 
know his surroundings, answers, upon being asked in a very 
loud voice, with much of an effort, that he is doing well, 
hearing obtuse, muttering, low delirium. No sleep for five 
nights, restlessness, furious delirium, has to be kept in bed 
by main force, subsultus tendinum. Head hot, skin dry. 
Pulse tremulous, uncountable. Lips and tongue dry, 
covered with brown crusts, swallowing difficult, a little 
cough. Abdomen flat, no gurgling, no sign of pain. No 
roseola. Discharge from the bowels and bladder involun- 
tary. — Treatment: Compresses to chest and abdomen to be 
changed every 15 minutes. Ablutions. 

January 24:th. H \ I day.) No sleep during the 
night, but the patient rested quietly. P. 150. Tongue 
moist. — Treatment: Every three hours affusions of three 
pails of water at 70° F., compresses. 

January 25th. (8 | 2 day.) The bathing seems to be 
pleasant to the patient. Consciousness present while the 
patient is in the batli. 



January 2Qth. (9 | 3 day.) Improvement of the brain 
symptoms; during the night, sleep, the first since eight 
days. Urine and stool no more involuntary. Expression 
of the face more lively, hearing better, answers more cor- 
rect and louder. P. 132, small. 

January 21th. (10 | 4 day.) The fever decreases, 
temp, almost normal, head cool, P. 120. Consciousness 
clear, hearing perfect, strength increasing. Evacuations 
not so thin and not involuntary. 

January 29th. (12 | 6 day.) Patient is worse; diar- 
rhoea again sets in and in the evening profuse hemorrhage, 
great excitement, heat, uncountable pulse. — Treatmeut: 
Absolute rest, ice-cold compresses to abdomen. Ablu- 
tions. 

January Zlst. (14 | 8 day.) Hemorrhage has not 
returned; the high fever continues, slight decubitus. 

February 1st. (15 | 9 day.) Herpes hoster appears 
on right thigh. Puis 120. One foetid discharge without 
blood — not involuntary. 

February bth. (19 | 13 day.) Improvement sets in. 
Furuncles and abscesses everywhere, herpes fully devel- 
oped, brain clear, appetite returning, passages begin to get 
normal.— Treatment: Half-bath of 28°. 

February 11 th. (31 | 25 day.) Complete recovery, 
after some difficulty in swallowing h'as been experienced. 

Oa.se XXIII. Very grave typhoid. Bilaterial 
pneumonic infiltration. Recovery. 

Mr. P. 24 aet. Merchant, always healthy, slight ail- 
ments excluded, does not feel well for 14 days. Suffering 
loss of appetite, vomiting and great loss of strength, (has 
one fainting spell,) but being of the opinion 
that he is merely suffering from a cold, he 
does not go to bed but takes a Russian bath. 



— 293 — 



(November 1st 1858.) But instead of getting relief from 
his supposed cold, his illness increases rapidly, rigors 
changing off with exhausting prespirations and diarrhoea 
are added to the symptoms and his weakness increases to 
such a degree that at last on November 3rd the patient is 
unable to leave his bed. November 4th cough sets in, at 
first of a dry character but afterwards accompanied by the 
expectoration of bloody colored mucus and thin blood. 
Two physicians diagnosticate double pneumonia. — Leeches 
calomel, mineral acids. So much the patient remembers, 
after this complete unconsciousness sets in. He is deliri- 
ous day and night and has to be kept in bed by force and 
in spite of everything being done for him all hope for rec- 
overy has been given up by November 14th. 

On this day at noon, to make a last trial with the 
hydriatic treatment I am called in, and find the patient 
completely unconscious, it is quite impossible to bring him 
back to consciousness for a moment by any means what- 
soever. Subsultus tendium and convulsive muscular con- 
tractions, red face covered with prespiration, eyes half clo- 
sed, moufh open, lips, teeth and tongue dry and covered 
with black crusts, pulse dicrotic, 120, body soaking wet 
from prespiration. Respiration anxious, 48. A more 
accurate physicial exploration being out of place under 
these circumstances, I order to begin with, the patient to 
be rubbed with two wet sheets, affusions to the head with 
water of 14° C. (57° F.) fresh linen and a nourishing diet. 
During the affusions the patient opens his eyes, but does 
not return to consciousness; after being taken back to bed 
he evidently feels more comfortable. Physical exploration 
reveals behind and below dullness over the thorax, especi- 
ally over the left side, with bronchial respiration, every- 
where else tympanitic resonance, and coarse mucous rales 



— 294 — 



all over the chest; tumefaction of the spleen, tympanitic 
distention of the abdomen, tendency to diarrhoea. 

At 5 o'clock p. m. a violent exacerbation, red cheeks, 
restlessness, moaning, pulse 140, respiration 52. When 
being rubbed now with a wet sheet the patient does not 
even open his eyes even if water of 8° C. (47° F. ) is being- 
used. Unconscious when brought back to bed, he remains 
(|uiet, does not moan, pulse goes down to 120, respiration 
to 36, no cough. Skin odorous, the streaming prespira- 
tion has ceased, evacuLitions from bowels and bladder 
involuntary. 

November IQth. (17 | 2 day. ) Unconsciousness con- 
tinue's unchanged but the nervous and vacular system 
quiet down, more and more, pulse 112, respiration 28 
The affection of the lungs does not make itself known by 
any symptoms, no cough, bronchial respiration and dull- 
ness still present. 

Under these circumstances I do not hesitate to have 
the patient transported while resting after his morning- 
bath and packed in his bed ( the temperature out doors 
Ijeing 8° C.) to my hospital, where he arrives without 
having been awakened. — Treatment: A half-bath of 28° 
C. (80° F.) with affusions ofl7°C. (63° F.) of LO minutes 
duration, compresses, bouillon. 

November 16//?, (Evenings.) Rest and sleep the 
whole day. with closed eyes and closed mouth, P. 90 — 100. 
respiration 28—30. Xo cough. Lips and tongue clean 
and moist, diarrhoea diminishing. At 8 o'clock j). m. 
severe exacerbations sets in. During the bath now 
ordered the first signs of returning conciousness present 
themselves. 

Nocember \~ith. [11 | 3 day,) lmi)rovemcnt of the 
brain — fever — and abdominal symi)toms. During the 
night ablutious are sufficient "to produce rest and sleep. A 



— 295 — 



9 o'clock severe exacerbation, one hour after the bath 
pulse 96, respira ion 24. No cough. The muscles have 
not yet quieted down. No evacuation for 36 hours. 

November ISth. (18 | 4 day.) Definite return of con- 
sciousness,evacuations no more involuntary. Appetite is 
returning, P. 84. R. 22, dullness and bronchial respira- 
tion have dissappeared. No cough, no expectoration, no 
sweating. 

November I9th. (19 | 5 day.) Improvement begins. 
Numerous furuncles superficial decubitus. No cough, no 
expectoration.— Treatment: Three half baths daily of 28° 
with affusions of 22°; compresses to abdomen only. 

November 21 st. (21 | 7 day.) The exacerbations of 
the fever cease. Pulse 72, rapid recovery; patient gets up. 
exposed corium makes lying down painful. 

November 24:th. (24 | 10 day.) Much pus evacuated 
from the furuncles, emaciation, weakness and irritable tem- 
per. No cough nor expectoration. 

December IQth. (47 | 32 day.) Recovery com- 
plete. 

Oase XXIV. Gravest typhoid, exudative ple- 
urisy, gangrene of lungs, recovery. 

Bertha S. 16 aet., of strong constitution, but irritable 
nervous system is taken sick after having been at work 
day and night preparing for the holidays, at the time of 
the epidemic of typhoid fever after short indisposition on 
December 4th 1858, with the symptoms of an angina. 

After the use of calomel and leeches these disappear 
and the patient begins to feel better, although a pulse of 
120 and a feeling of heaviness remains behind. Decem- 
ber 10 a stitch in the right side of the chest sets in increas- 
ing rapidly in intensity and accompanied by cough and 
oppression. Inspection reveals diminished motion in the 
right side of chest, percussion, dullness behind up to the 



— 296 — 



middle of the scapula and in front to the nipple, ausculta- 
tion absence of respiratory murmur over the lower part of 
the right lung diminished over the upper part, rales in 
both lungs; pectoral fremitus absent on right side, resist- 
ance on percussion great. Respiration increased, short 
drf cough, pulse 130 small; tongue coated, dry, spleen 
enlarg'ed, abdomen distended, stools liquid. Exacerbation 
of the feyer marked towards eyening, moderate delirium 
at night. — Treatment: Infusion of digitalis with tart, 
emet., compresses to chest and back eyery half hour. Dec- 
ember 12th, exudate somewhat diminished, fine mucous 
rales oyer compressed lung, increase of the stupor. 

December \A:th. Exudate the same, increase of fine 
rales, which can also be heard lower down. Consciousness 
more dull, much excitement and delirium towards eye- 
ning. 

December loth. Further increase of the symptoms, 
temperature high, P. 140, R. 48, unconciousness complete, 
eracuations inyoluntary. Bronchial respiration at lower 
apex of right scapula. 

December 16th. Diagnosis of typhoid feyer estab- 
lished, water treatment begun: medicines discontinued. — 
Treatment: Warm full bath of 35° (95° F.) affusions 
with water of diminished temperature, cooling down of 
bath to 2 7° (80° F,) 10 minutes. Unconciousness contin- 
ues in and after the bath, patient howeyer more quiet and 
resting, P. 130, R. 40, sleep. After three hours, exacerba- 
tions. No return of consciousness after the full bath, only 
after the third bath in the morning at 6, there are signs of 
such. — Treatment: Full-baths of 35° (95° F, ) affusions 
of 17° (63° F.) 10 minutes, compresses to chest and back, 
ablutions. 

December \1th. Conciousness clearer, cough seyere, 
dry, disturljing the rest, oppression, physical signs the 
same. Feyer somewhat less, 



— 297 — 

December 22nd. After apparent improvement (dimin- 
ished fever, easy expectoration,) to-day bloody discolora- 
tion of the sputum which is of very foetid odor spreading 
into the neighboring apartments an extraordinary chapge 
for the worse; complete unconciousness, delirium, very 
kigh fever, collapse, face pale, lips blue. Danger increases 
from hour to hour. — Treatment: Full bath with affusions 
as before, every four hours. Nourshing diet. 

December 23rd. Contrary to expectations, the patient 
has survived last night, a terrible one. Some little improve- 
ments; signs of returning conciousness, expectoration 
more vigorous, sputum abundant, if possible of stronger 
odor than that of the previous day; dyspnoea less, cough 
and fever the same. Discharges involuntary. — Treatment, 
the same. 

After the most pressing danger has been overcome 
for the second time by the aid of the warm baths and affu- 
sions, consciousness gradually returns, the gangrenous con- 
dition of the sputum dissappears, dyspnoea and fever dim- 
inish, especially with the appearance of furuncles. — Janu- 
ary 1st 1^^59 the number of baths can be reduced to two, 
the compresses omitted entirel3^ Physical exploration 
does not reveal much of a change excepting that the*bron- 
chial has been replaced by cavernous respiration, and the 
rales have decreased in number, metallic tinkling and 
amphoric resonance absent. In the beginning of February 
she leaves her bed; signs of aemia very marked. Hydri- 
atic treatment discontinued, Iceland moss and Helm's pills 
are ordered for the cough lasting into the summer. 

July 1860. The lungs are found completely healed, 
bronchial respiration has'disappeared, respiratory murmur 
somewhat diminished over the afficted part; the form of the 
thorax has not been changed. She later on lost her hair. 



— 298 — 



[These last four cases have been added to 
illustrate the treatment of the complicated cases. 
Several others also, answering the same purpose 
have been related previously. S.] 



APPENDIX A. 



Personal Experieace ia Using the Water Treatment. 

In this part of the volume I intend saying 
a little about my own experience with the water- 
treatment. Not that I wish to bring owls to 
Athens; my observations have not been recorded 
with sufficient accuracy, nor made according to a 
sufficiently definite system, to form the basis for 
scientific deductions and reasoning. Further- 
more they cover the first period of my experience 
with the water treatment, when serving my 
apprenticeship, and shortcomings and mistakes 
in the application of the method would be apt 
to make such observations of but little value. 
Still it may perhaps be of interest to the reader, 
with what degree of accuracy and how exten- 
sively an ordinary practitioner in private prac- 
tice is able to follow the directions given in the 
previous chapters and to carry out the method; 
and how under circumstances as we daily find 
them among the laboring classes with limited 
means and appliances the results obtained here 
will compare with those obtained under more 
favorable conditions, I shall therefore make 
some remarks as to how the method can be and 



- 300 — 



was carried out, further concerning the favor 
with which it was received by the patients and 
their friends, the difficulties that had to be over- 
come and the aids one finds in carrying out one's 
plans. My ow^n experience would thus demon- 
strate what results my colleagues might reason- 
ably expect to obtain. I hope that others will 
thus be encouraged to give the method a trial, 
especially such as have more intelligent and 
well-to-do patients, w^here the nursing can be 
carried out w^ith still more accuracy than was 
possible amongst my patients. I hope that 
many wdll give the method a thorough trial, 
th()Ugh they may not yet have absolute faith in 
it. 

For about 20 months I have been trying 
the method. But why have T not done so 
sooner? I and perhaps others have not done so 
because we Avere w^aiting for those sitting on 
Moses' stool to do so first, and because we ordi- 
nary practitioners, especially #s long as one 
counts himself with the younger members, 
assume as a matter of course that those men who 
take upon themselves the responsibility of 
instructing others and keeping them in- 
formed about valuable additions to our art and 
science, are better equipped to test and weigh 
the value of any new method. Here I am con- 
vinced I made a great mistake. So when the 



— 301 — 



statistics of the results of Brand's method passed 
under my eyes, I made up my mind to go ahead 
myself, and not wait for another edition of ' 'Pep- 
per's System" to prop me up. I had a large 
bath tub made of galvanized iron, and set it aside 
waiting for a case to use it. 

Using the method it became clear to my 
mind why it v/as folly to wait for authors and 
professors. It is customary to have new methods 
tried in hospitals first, and when found success- 
ful here the genreal practitioner is willing to 
use them in private practice. If we American 
physicians intend to wait for good results in 
American hospitals, we can wait until doomsday 
and not see any; and this for two reasons. In the 
first place, the cases come under treatment far to 
late for the method to have a fair chance. Brand 
himself points out on analogy to the antiseptic 
method in surgery ; only when the surgeon has 
control of the wound from its beginning, and 
even before it is produced, can he expect the 
beneficial results of the method and not when 
the wound has been exposed for five or ten days 
to all sorts of influences; so also we cannot 
expect the preservative and stimulating qualities 
of cold water to do good after there is nothing 
left to preserve and stimulate. In the second 
place, I have my doubts whether in any hospital 
where the attending physician has not the full 



Control of the nurses, the right to employ and 
discharge them, he can expect the cold water 
treatment to be carried out accurately, so as to 
show its full beneficial effect. 

Nor do there exist perhaps in many hospi- 
tals the necessary conditions for carrying out 
the method even though the hospital authorities 
have the good will to have this kind of treatment 
carried out. Vogl says that his patients are 
treated in frame pavilons 100 x 20 feet in 
dimensions, each containing 30 beds and richly 
supplied with windows. Four of these beds are 
occupied by the nurses, who sleep in the wards, 
and as each case of considerable gravity has two 
beds at its disposal, not more than 12 patients 
of this character are admitted into such a ward. 
Each three patients thus would have a nurse at 
their disposition. The bath-tubs, two in number 
are placed in a separate room at the gable end 
of the pavilion, where the patients are conveyed 
so that the remainder of the patients are not dis- 
turbed by the procedure. Such arrangements 
we cannot look for in our hospitals, but may we 
not hope that the American public will aid the 
profession in this direction? Untold blessings 
would revert to the public if the medical students 
could be thoroughly trained in the use of water 
in the treatment of typhoid fever (and other 
diseases. ) 



— m — 



As I said before I had a bath-tub made in 
1889, six months before I had a patient to use 
it, and having* no one to advise me here, it was 
a little too large : 6x2x1^ feet. Since then I have 
had four more made 4^ to 5f feet long. I think 
5^x2 feet by 16 inches (high) will prove a con- 
venient form for the majority of cases. My tubs 
are made of galvanized iron, are quadrangular, 
and I suppose Oscar Wilde would be able to 
offer some criticisms. Hoffman & Heman of 
Pearl street made them for me at a cost of about 
S6.50 for each tub. Anybody who wants to try 
the method should have his tub on hand, and 
also -his thermometers; an ordinary thirty-five 
cent thermometer for the bath, and a fever-ther- 
mometer for the patient. Having everything in 
readiness will make a good impression on the 
patient and his friends: it will not do, besides 
often no time is to be lost, to send a family, 
stricken by such a calamity, from one tinsmith 
to another to get a tub made. Furthermore, 
expense can thflsbe saved to the patient. 

A board placed slanting in the tub to sup- 
port the head allows the person to be dispensed 
with who otherwise would have to hold the head 
When in use it may be covered with some soft 
material, (towels, pieces of an old quilt, etc.) and 
a few nails acting like hooks will prevent the 
board from slipping into the water. The patient 



§04 - 



thus farther has the back part of the head and 
nape of the neck constantly in the water, which 
circumstance would seem in a measure to take 
the place of the affusions. I intend further 
providing my jDatients with glazed iron vessel 
the capacity of which is know^n ,for the purpose 
of ooUecting the urine passed for 24 hours, the 
quantity of urine passed being a good sign of 
the accuracy used in carrying out the method 
properly. 

The tubs mentioned were so made as to allow^ 
the patient to lie down and rest his head on an 
inclined plane. Perhaps another form deeper 
and shorter, in which the patient could remain 
in a sitting position would be more preferable, 
especially when affusions to the head are neces- 
sary or desirable. 

Enumerating some of my cases I shall add 
remarks here and there as they occur to me 
without any system. 

Case I. Miss. Gl. was a young lady, rather 
stout, about eighteen years of age. Wit this 
case two circumstances are connected which are 
of interest in this matter. The girl was taken 
sick suddenly with a chill, and I was looking for 
an apical pneumonia, in fact, thought I had de- 
tected some physical signs, when after six to 
•even days, diarrhoea and tympanites set in and 



— 305 — 

the diagnosis was clear. This leads me to speak 
of one of the difficulties in the use of the 
method. I there are no other cases around, I do 
not see how w^e can make a positive diagnosis in 
a good many cases in the first days when accord- 
ing to Brand the treatment ought to begin to 
have absolutely good results. I do not see how 
one can distinguish some of the pneumonias with- 
out pain, or some perityphlitides not to mention 
malarial fevers, where those are prevalent. Ty- 
phoid is one of those protean diseases, which 
varies a great deal, and typical cases we meet 
more frequently in books than in practice. That 
it is not only lack of skill on my part I can 
prove by a case which I saw as a student. I was 
making the rounds with the attending physician 
in the Charite, when we came across a young 
man in a typhoid condition and with high fever. 
The patient was examined carefully, the diag- 
nosis, as the most probable, was typhoid fever, 
and a cold bath was ordered. Wishing to see 
the method emplohed, I remained to see it ap- 
plied. The cold water into which the patient 
was submerged produced deep respiration, 
cough, and the expectoration of rusty sputum. 
^'Eine Pleumonie," exclaimed the nurse. Now 
suppose this had occurred in private practice 
here. Suppose the patient had died; suppose 
the family thought fit to institute a malpractice 
20 



— a06 



suit — would it not be a rather unpleasant situa- 
tion? There would no doubt be found old wo- 
men of the male sex in the profession, who had 
no doubt that the cold bath was the cause of 
death, etc. The patient did quite well and 
showed no ill effect from the bath. 

Now that H. C. Wood can be adduced as 
authority for the harmlessness and usefulness of 
the method in this country the danger from le- 
gal complication need not be feared so much. 

The second circumstance connected with my 
case was that the young lady (perhaps partly on 
account of her delirium) was longing for the re- 
petition of the baths, at least for some days, un- 
til the very high temperature had abated, 
when she disliked them as much as most of the 
patients do. 

And this, then, has to be said here: By far 
the majority of the patients have a great aver- 
sion to the bathing. They fret, perhaps cry, 
protest, ask to have the manoeuver postponed, 
and take care of the minute hand of the clock so 
that they do not get more than their share. If, 
therefore, I meet a case of typhoid fever I in- 
form the family what I intend doing if the case 
should require it. I explain to them that it 
will seem like a dangerous and actually will be 
a somewhat harsh-looking treatment; that the 
patient himself will not take kindly to it, but 



— 307 — 



will protest ; that the shivering in and after the 
bath, the cold hands and feet probably, nay 
certainly, alarm the inexperienced; and if the 
friends or patient should have decided objection 
to go through such experience, they had better 
not try the method but call in another phy- 
sician. For if a family or patient should not 
have the necessary confidence in me to submit to 
this treatment after stating my reasons, I think 
we had better part company. I can say, how- 
ever, that I had not half the difficulty in em- 
ploying and introducing this method that I an- 
ticipated, and which my colleagues, to whom I 
may chance to speak on this subject, bring upas 
an objection. I feel, let me say here, some pride 
in ray patients for having allowed me to carry 
out my plan, as they had no precedents here in 
the city to which I could point them. 

It would seem to me that in an intelligent 
family to which the reasons for adopting this 
line of treatment can be explained, there ought 
to be no difficulty in having the cool baths used, 
especially as we can assure the patient and his 
friends of the harmlessness of the procedure. 

I expected in this patient on account of her 
full habit and age and sex an illness of about six 
weeks, but Avas agreeably surprised, to find that 
after carrying out the method for a number of 
days, such a marked change for the better oc- 



— S08 — 



curred, that we had no more than a three week^s 
ilhiess, aside from the trouble which a very deep 
bed-lone gave us. Perhaps on account of the 
late date of the beginning of the water-treat- 
ment a deep wedge-shaped slough formed in the 
anal fold reaching dowD to the bone. This my 
first case encouraged me very much. 

Case II. Miss Hae. This also was a young 
lady, over 20 years of age. She was not so 
pleasant to treat. I experienced here that it re- 
quires some firmness to carry out the method. 
A lady friend, w^ho took care of her, and ^ 'whose 
son recovered from typhoid fever without the 
use of baths", did not support me very much 
in my efforts. Yet the spiritual adviser of my 
patient having seen the method employed in 
Germany was on my side, so that I did not have 
to yield. The first bath the patient had when 
her temperature Avas rising rapidly (105 F.) and 
her nose was bleeding. The action of the baths 
was prompt and eifective. They were very un- 
pleasant to the patient and she gave us a great 
deal of trouble. 1 was somewhat surprised to 
see that on recovering she lost all of her hair, 
when I considered how mild the course of the 
disease was after the baths had gained the vic- 
tory over the fever. 

Case III. Mr, Hen. Was a man, whom I 
found with atemperature of 106°F. Within a 



— 309 — 



few hours he was in a bathtub, and the baths 
acted very promptly and efficiently. The disease 
took a pleasant course and this patient improved 
more rapidly than I had anticipated. 

Case IV. Pig. was a girl about 18 years of 
age. This leads me to answering the question as 
to the number of baths that I have found neces- 
sary. This case proved the most stubborn in the 
first years of my (hydriatic) practice. The tem- 
perature would be lOS'^ F. before thebath, 103°F. 
one hour after thebath, 104° F. two hours after 
the bath and 105° F. three hours after the 
bath, and this condition continued for 10 days. 
She received 7 baths every day, beginning at 
6 o'clock in the morning and ending at 12 o'clock 
at night. Ahmg the 11th and 12th day the 
fever declined rapidly. Having at that time not 
read much about the methods I ordered on ac- 
count of her age and immaturity the duration of 
the bath to be 10 minutes. This perhaps was 
not correct, and the omission of the 3 o'clock 
A. M. bath was not commendable. I doubt 
whether the mother, who had to do all the nurs- 
ing, w^ould have been so faithful tn pursuing 
the method, had she not lost a child some years 
before from typhoid fever ; furthermore the 
mother felt satisfied that the baths had a bene- 
ficial effect on her child. I think that the least 
resistance to the metbQcl will be found and the 



— 310 — 



treat meut will be carried out ^vitb the greatest 
accuracy in families that have sufferefl a loss 
from this disease. In handling this case I also 
learned how some of the laity explain to them- 
selves the action of the baths. They imagine 
that the water draws the poison out of the sys- 
tem and thus look upon a bath which the patient 
has used as a sortof tincture of typhoid-fever, and 
of course consider it necessary to renew the wa- 
ter for each bath. This woman had carried her 
cistern dry — I am sorry to say — acting on this 
theory, I having neglected to mention to her in 
the beginning that the same vrater would do ser- 
vice several days. It is well to call attention to 
this point at once. 

As to the number of baths given in any one 
case the bath-tub generally was left by the bed- 
side for 7 — 8 days and at least 36 baths were 
given in almost all cases. Many patients required 
many inore baths than that . 

Case V. Alb. Was a girl about 15 years 
old. The father had had an attack of tpyhoid 
fever ten years previously, when he was furi- 
ously delirious. He had been treated on the 
hot plan, and seeing the pleasant effects of the 
water was only too sorry, that he had not been 
himself treated with cool baths. 

Case VI. CJn\ M. This was a young 
man whose brother had died of typhoid fever H 



— 311 — 



years previously. The disease was a week old and 
well developed when he came under treatment 
The temperature was high and the diarrhoea pro- 
fuse. He proved to be one of my worst cases, 
although the baths acted favorably and the pat- 
ient was, though semi-delirious, glad to take 
them. He developed an abscess over the paro- 
tis and an inflaraation of the hip-joint, leaving 
the same permanently stiff, and had intestinal 
hemorrhage in the fifth week. The treatment 
was admirably carried out. I mention this case 
to show that my cases were not all mild. 

Case VH. Wit. Was a young man, the 
disease was of medium gravity. His mother, a 
widow, took care of him, and some of the old 
women of the neighborhood helped us in the pro- 
cess. This leads me to speak of neighbors. 
Those who have learned Dr. Luther's catechism 
know that this practical and noble man mentions 
''good neighbors" as belonging to ''our daily 
bread. ' ' The practical physician will often have 
occasion to attest the truth of this statement. 
In the water-treatment the neighbors may be of 
the greatest aid to the physician and they may 
be one of his worst obstacles. At times he will 
have to fight the patient, the patients mother 
and grandmother and other relatives. If the 
neighbors also come in after the physician has 
left the house and discourage the family, he 



may wish that there were no neighbors. On 
the whole however I have gained more 
from neighbors in the prosecution of this 
method than the contrary. I have never seen 
any of them infected by the patient. Often 
without their aid it would have been impossible 
for me to have had my measures carried out. 
My patients whose means are way below pro- 
fessional or paid nurses are cared for better than 
patients in the wards of a hospital, and I would 
suggest neighbors to my colleagues as valuable 
auxiliaries in this work. 

Case IX. Mr. X.<t. Of this case I happen 
to have j)reserved the record and find that he had 
56 baths; it was not a mild case. Here I often 
observed that the early morning temperatures 
were unusually high. Since reading T. cv- B's. 
book I explain this fact by the circumstance, 
that no baths in general were given from 12 
o'clock at night to 6 o'clock in the morning, 
which intermission I permitted to give the atten- 
dants rest — if the patients also slept, which was 
the case — although this method is perhaps not 
entirely commendable. This patient always 
had a slow pulse, but a slow pulse is no indica- 
tion of the mischief which the poison may ^^ro- 
duce in the body 

Case XI. ^ Mr. Alb. Was a good deal of 
interest to me because the patient, a man of 30 



— 313 — 



aet. came under treatment when sick about five 
weeks, after having been treated medicinally by 
another physician. Although all local disturb- 
ances — chest and abdominal — were absent, he 
had had no sleep for a number of days, and I 
found him with a pulse of about 120 and a tem- 
perature of about 104. He was lying in a deep 
stupor, with his eyes open, stiff from rigidity of 
the muscles of the bacl^, so that he had to be 
rolled over like a log, for the purpose of taking 
his temperature. In the absence of any serious 
pathological changes, I had him bathed accord- 
ing to the formula, and next morning — I had 
seen him in the evening — I found a most w^on- 
derful and pleasant change. His lips, w^hich 
had been j^arched were now red and moist, he 
protruded his tongue and rolled over on his side, 
when asked to do so, the temperature had gone 
down without perspirations, and but a few^ baths 
daily w^ere necessary to keep him in a comfort- 
able condition, neither was medicines required to 
procure sleep. His mother-in-law had been and 
continued to be his principal nurse, and the 
opinion she formed about the baths, leads me to 
say a few words about what my patients and 
their friends think about the method. I believe 
I can can say that those who have become 
acquainted with the method, patients as well as 
their friends, are well satisfied with it and place 



— 314 — 



couiideuce in it, notwithstancUug that the bath 
itself may have been unpleasant to the patient 
and its use a source of extra work to his friends. 

The good woman who took care of this pat- 
ient, had to nurse a daughter-in-law and her own 
daughter about 12 years of age, after taking 
care of this patient, and she repeatedly express- 
ed herself that haying seen the medicinal and 
the hydriatic plan of treatment, she had no use 
for the former, but willingly would undertake the 
extra labor, which the method entails, when the 
daughter and son's wife required the baths. 
Undoutedly she prefered to see those dear to 
her in a bath than tormented by delirium. I 
think I can also say that my patients in gen- 
eral haye advanced so far, that they no more 
fear the cool baths, they only dislike the trou- 
ble they make and fear the unpleasant sensa- 
tions connected with the use of the baths. 

The plain people can see too plainly 
the good effects of the method, so that I even 
now have but little trouble to induce 
them to use the water, Of all my 5-4 
cases, only two refused to try the method irhen I 
proposed it, and these two died. Nor can I see 
why people should refuse to follow the advice 
of their physicians in this case. They have 
their abdomens cut open, their legs and arms 
amjDutated, take cloroform and what not, and 



— 315 — 



why should they refuse to step into a cool bath 
which we can assure them is a procedure free 
from danger? Of course as long as the physi- 
cian has no faith in the method, and proposes 
it in a half hearted manner, leaving the choice 
perhaps to the patient, he will have refusals 
enough. On my mind the results, that others 
have obtained, have made an impression strong 
enough for me to feel, that I am not doing 
my duty to my patients, should I not treat 
them according to the hydriatic method. 

Suppose a lymph had been discovered in 
Stettin, which could show such results as the 
cool-bath-treatment actually has done, would 
not the steamers have been carrying many more 
iVmerican physicians to the coast of the Baltic 
sea, than they did to Berlin last winter? Or if 
it were a surgical operation, which would have 
such a showing would not Stettin be a Mecca 
for the great and small operators as Birmingham 
has been? I for my part do say, that if I am 
not to heed the publications that have appeared 
on this topic, I do not see why I should read 
another article containing anything about thera- 
peutics and follow its advice. Why the intelli- 
gent American people, who claim to love water, 
should reject this form of treatment, which by 
the way seems more aristocratic to me, than 
swallowing an indefinite amount of medicines, I 



— 316 — 



cannot understand, nor do I believe that they 
will after their physicians have been convinced 
of the great power for good, which lies in this 
method. And when I hear the objection from 
physicians, that their patients will not submit to 
this line of treatment I ca nnot help thinking of 
the words: --Denn was die Herren den Geist 
derZeiten nennen, ist meistens nur der Herren 
eigner Geist." 

Case XIV. Mrs. Silh. Was of some 
clinical interest, because the patient, a woman 
of about 40 aet, had a continued fever of a very 
moderate temperature (101 — 102° F.) for nearly 
three weeks, when, while I was looking for recov- 
ery, the temperature rose higher, 104 and over, 
the pulse increased to over 130, and some days 
later delirium set in and I commenced the cool- 
bath-treatment, which was carried out faithfully 
for a week and more. She a first liked the 
baths and was willing to be placed into the 
water, but later on she protested violently so that 
her husband had some trouble. At my visits 
she always was quiet, slept well between the 
baths, and I was somewhat surprised when, after 
her recovery, she informed me that she did not 
recollect having had a single bath. After her 
sickness her little daughter 10 years old had the 
disease. She had a violent nose-bleed in the 
first days, a circumstance which rather induced 



§1? — 



me to use the method. She did not require so 
very many baths and considering the paleness, 
which she generally exhibits I used baths of a 
somewhat higher temp, than the formula. The 
effects of the baths was pleasant. 

Case XVI. Mrs Hll. Was a woman 
about 40 years of age, sick five days, T. 104, 
diarrhoea and abdominal tenderness present, 
when she came under observation. While after 
a few days of treatment the temperature went 
down ^ist as Vogl describes it the diarrhoea 
continued in spite of cold compresses to the abdo- 
men, in spite of enemata of laudanum, in spite of 
bismuth, lead acetate etc. On the 28th day she 
had a violent intestinal hemorrhage and lost per- 
haps a quart of blood while pain and meteorism 
continued for a week and more. She was bathed 
about a week, 40 — 50 baths being necessary, and 
finally when well on to recovery developed a 
harmless anasurea. Case XIX. was another 
which had intestinal hemorrhage. I mention 
this fact to characterize the class of cases I had 
to deal with. 

Case XXVII. Mrs, A. was the delicate 
wife of a physician who had lost a brother from 
typhoid fever a few months previously. The 
baths acted as desired. 

Case XXVIII. Mr, Sp, was a man about 35 
aet. who had lost a" sister some months pre- 



— m — 



viousiy from the fever. He did not recollect 
much about the first baths, but it took some 
coaxing to have him take the baths along the 
5th to 7th day of treatment. The action of the 
baths was as it should have been. 

Case XXIX. Miss Fcl'., a girl about 14 
years of age. We had a good deal of trouble 
with the first baths which were given the very 
night I saw her the first time, when her temper- 
ature was 104°, and the pulse rapid. She was 
one of the patients who had less aversion^o the 
the process as it was continued. She did how- 
ever not require many baths. After 4 to 5 days 
but few were necessary, not more than 4 to 5 a day 

Case XXYIII. Mr. Sch. was one of the 
four cases I saw where the spleen could be felt. 
He liked the baths and was sorry when the tub 
was taken away. The baths acted according to 
Yogi, perhaps because he was treated from the 
very beginning. He also developed the anasarca 
during recovery. 

Case XXXII. Miss Ma. a young girl of 
about 20. She also liked the baths. Further- 
more she generally could tell by her feel- 
ings when a bath was necessary. Although a 
rather mild case she had over 50 baths. 

Case XXXIII. J. Sch. a boy about 14aet. 
This patient always had a dark red tongue and 
a dicrotic, though not very frequent, pulse. He 



— 319 — 



was the son of a poor widow, who with but a 
little assistance did the nursing. I think this 
case shows that in the majority of cases the 
method can be carried out if the friends of the 
patient are willing, for what this woman did 
most people are able to do also. And after all 
the whole procedure is not so formidable as one 
might imagine it to be. I shall say here a few 
words about the way I carried out the method. 
Having decided upon using the baths, I select 
the most suitable room in the house and 
have the bed placed therein, at the same time 
the bathtub is brought to the house and placed 
either alongside the bed if it is a severe case 
that must be lifted into the tub, or anywhere in 
the room in case the patient is able to walk. 
I have the patient provide some good whiskey 
and a jug to be filled with water to be placed 
against the feet after the bath. I order the bath- 
tub to behalf filled with water from the hydrant 
and hot water to be added until the bath has a 
temperature of about 85, that is if the case is not 
urgent. At the same time I instruct the most 
suitable person present in the use of the clinical 
thermometer. I allow him to introduce the instru- 
ment dipped in lard etc., and after letting it re- 
main two minutes read it while I am present, and 
shake the mercury down. I have advised my nur- 
ses to handle the thermometer over the bed , so that 



in case it should drop, it would not break. Still 
a good many of my instruments have been bro- 
ken. AVomen have more accidents with them 
than men. If possible, I am, in case of a male 
present myself at the first bath, otherwise I send 
one of the persons, that I have trained, to see 
that everything is carried out as it should be, 
and to encourage the family and the patient. I 
also always make a second visit in the first 24 
hours, to convince myself that everything is un- 
derstood which so often has not been the case. 
The first bath I often have given at 85° F., the 
second at about 80°, the third at about 75° 
the fourth at about 70°. Often it is simply 
necessary after the first bath is prepared at 85° 
to let it cool down itself, at times cold or hot 
water must be added. If the patient is able 
and willing to go into the bath, one person is 
sufificient. If he has to be lifted into the bath 
two persons are desirable, one taking hold of the 
ankles, the other under the arm. One of my 
patients claimed, that in her case a rapid im- 
mersion was not as unpleasant as a slow stepping 
in, first with one foot then with the other etc. 
I always had my patients rubbed well; whether 
the s})onge or the hand is preferable I could not 
say. Affusions I have not used so much, be- 
cause the nervous symptoms were not so very 
marked, but shall employ them in cases with de- 



- m - 



liriiim. The chill and the cold hands and feet 
will of course alarm the patient and his friends, 
and if one can manage to be present when the 
patient is in that condition it will be very en- 
couraging to his friends, because they cannot 
but be afraid, that perhaps the thing had been 
overdone at the time and that some harm might 
have been done. If the physician then can tell 
them that this condition, which he sees, is just 
what must be brought about if the patient is to 
derive benefit, the attendants will become more 
courageous. At first they w^ill of course have a 
good deal of feeling for and commiseration with 
the patient, but as they see the patient improve, 
sleep after the bath, get stronger, have better 
appetite, even a mother will get more hard- 
hearted, and will not mind the somewhat pitiful 
aspect, which the patient presents after he gets 
out of the bath. If the patient cannot be dried 
while standing, I have an old quilt or comforta- 
able placed on the half of the bed next to the 
tub, on which the patient is dried and then 
rolled into the middle of the bed. A jug with 
hot water is now placed against the feet, the legs 
are wrapped up in w^arm flannels, and the at- 
tendants charged not to cover up heavily the rest 
of the patients body. The cold compresses to 
the chest and abdomen I have applied when the 
heat of the surface returned in all the severer 
21 



— m — 



cases, and several times a day (not after eacli 
bath) I have the teraperature taken to be able to 
form a conception of the resistance of the body 
to the cooling process. 

In the first year of my (hydr.) practice I 
had the baths given when the temperature had 
reached 103. I now follow Brand and other au- 
thorities more closely and have a bath given at 
102. The water of our hydrants being about 72 
in summer, my ordinary formula was a bath of 
72 every three hours, when the thermometer in 
the rectum registered 102 (full). 

The attendants keep a record of the meas- 
urements, so that, when I enter the room, I can 
see at a glance much of the patient's condition. 

^To facilitate the keeping of the record I 
have had some blanks printed of which a sample 
will be found at the end of the volume. There 
will also be found there a blank for the purpose 
of conveniently recording the temperature curve 
and other important data of any case. 

Case XXXIV. May. was my youngest pa- 
tient, a litte girl 19 months of age, whose father 
died from typhoid fever 2 years previously — 
before I kne\v how to use cold water. Her 
mother had a febrile disease with low morning 



*) Note. These blanks I shall furnish at reasonable 
prices. 



— 323 



and high evening temperatures and diarrhoea, 
which I looked upon as an atypical case of en- 
teric fever. The little patient received as many 
as 100 baths, and had high temperature (105°F.) 
developed a broncho -pneumonia, with but little 
consolidation in the end of the second week, 
which w^as very slow in disappearing. Having at 
that time not yet read Brand's advice I had the 
baths perhaps a little too w^arm (80 — 75 F.) and 
of 10 minutes duration. Perhaps it would have 
been better to have taken the water a little 
cooler, about 70 and have had the baths last only 
7 to 8 minutes. The patient made a rather slow 
recovery and developed a purulent nasal catarrh. 
In her case I did not see that the desire for nour- 
ishment was awakened by the baths. 

Ca8E XXXVII. Miss W. was one of the 
cases where the baths acted like a charm. A 
girl about 20 aet., who had taken care of a fam- 
ily ill with typhoid fever, was herself taken ill. 
Two days later I found her with a temperature 
of 105, pulse between 130 and 140 tongue dark 
red. She was suffering from the fever and had 
not slept for two nights. One night cool bathing 
brought about a most marked result. She felt 
and looked like a different person. The effect 
of the baths had been pronounced producing a 
fall of 3 to 4° F. In fact 3 to 4 baths a day 
sufficed to keep the temperature around 102, and 



— 324 — 



her improvement may be^ dated from the night 
the treatment was instituted. 

Case XXXVIII. A. G. was a lad of 14 
who was interesting to me, because his parents 
had come from Munich, where in former years 
they had lost a child from typhoid fever, but 
knew nothing of the bath treatment. It seemed 
curious that a patient should have traveled so 
far away from Vogl to get into a bath-tub. The 
patient was well nursed (although many a phy- 
sician would perhaps have never ventured to 
propose the treatment considering the poor and 
uninviting surroundings). The mother seeing 
her boy gain in strength from bath to bath was 
very faithful in carrying out the treatment. Be- 
fore the fever had disappeared the tongue had 
almost cleared off and the patient was longing 
for meat, which of course was not given to 
him. 

Case XXIII. was a fatal case. Mrs. 0., a 
rather plump woman of about 45. She was not 
taken care of as well as my other patients, and 
there being no symptoms but high fever T. 104 
P. 120, when she came under observation I hes- 
itated to use the baths for some days, at that 
period of my experience not being willing to 
treat any case where the diagnosis was not sure. 
I do not think that she received more than 12 
cold baths. 



— 325 — 



Case XXX. Mr. Sch. was also a fatal 
case. He was one of my worst cases, tried to 
keep on his feet (unloading iron-ore) while sick 
for several days; diarrhoea and high fever had 
developed when he came under treatment on the 
sixth day. Although bathed properly — , he had 
52 cold baths in the first seven days — . I suc- 
ceeded very indifferently in depressing the curve 
and as soon as we had lower temperatures (103 
F.) the patient refused to be bathed any further; 
whereupon the temperature went up again. Al- 
though the balhs were during the second week 
not omitted altogether, yet the energy of the 
attendants — to act against the wish of the 
patient — gave out, so that not as many baths 
were given as was necessary. Nor was I success- 
ful in checking the diarrhoea, in spite of the 
compresses. Finally the bathing was refused 
altogether and I withdrew from the case. While 
attending there had been blood in the discharges, 
so that I was not surprised to hear that he had 
died from "peritonitis". 

Case XL. Miss Z. a teacher in the public 
schools. Of this case I have the accurate record, 
which follows, showing that the number of baths 
were 134 given in 20 days. 



— 326 — 



Dav 
of 

Sickness. 



Highest and lowest 
temperatures 
Before Bath. 



Average of 
the 
Maxima. 



Xo. 

of 
baths 



Temp. 

of 
baths- 



.10 
.11 
.12 
.13 
.14 
.15 
.16 
.17 
.18 
.19 
.20 
.21 
.22 
.23 
.24 
.25 
.26 



.103,5 101,5. 

.104,0 101,5. 

.103,5 101,5. 

.102,0 101,5. 

.100,5 100,0. 

.101,5 100,0. 

.102,5 101,0. 

.104,0 101,5. 

, 103,5 102,5. 

,.104,0 102,0. 

.104,0 103,0. 

,.105,0 103,5. 

,.104,5 103,2. 

,.103,0 101,0. 

,.105,0 102,0. 

,.104,0 103,0. 

,.103,5: 101,5. 

,.102,5 100,0. 

,.102,0 100,0. 

,.101,0 100,5. 



.102,5 4 , 

.103,5 8 , 

.102,5' 8|, 

.101,2 4!, 

.100,5 3|, 

.100,0 2;, 

.101,5 5', 

.102,5 ej, 

.103,0 
.103,2 
.103,4 
.103,8 
.103,9 
.102,0 
.103,5 



.70 



...8 

.11 
.11 
.10 

.103,3 11 

.102, 5|. 9 

.101,1 5 

.101,1! 4 

.100,51.. 2 



....72 
....72 
....75 
....75 
.. 72 
....70 
....68 
....68 
....64 
....64 
....64 
...64 
....64 
....64 
....64 
....64 



.80 



This case was of interest to me on account 
of a number of practical points connected with 
it. In the first place, it is the case which re- 
quired more baths and cooler baths than any 
other in my practice. In the second place, I 
was somewhat loath to commence the process, 
because having been consulted by the patient 
previously, I was a little apprehensive of tuber- 
cular trouble, knowing that I would have to 
hear the odium of having done harm to the 
patient if developements in this direction should 
take place. When she came under treatment 
^be w^s ill 4 — 5 days and no pathognomonic 



symptoms then were present, although vomiting 
and purging had opened the scene. Neverthe- 
less when on the sixth day the evening temper- 
ature w^ent up to 104, we commenced to bathe, 
and after three days of energetic treatment had 
the satisfaction of seeing the fever decline. At 
the same time a little blood appeared in the pas- 
sages, which aided in establishing the diagnosis. 
Along the 10th — 12th day perspirations ap- 
peared with general improvement, so that the 
bath tub was sent away, some baths were after- 
w^ards given in a stationary tub. 

As the table shows, from the 13th day on 
there was an increase of the temperature, at the 
same time the pulse, which during the first ten 
days had kept below 120, went up to over 140. 
The tub having been brought back, the baths 
were given exactly according to the formula and 
even cooler. The fever w^as obstinate. After 
the bath the reduction of the temperature was 
two and more degrees which was ample, but the 
previous high temperature w^as again reached 
too soon. The number of baths were increased 
so that eleven were given and on the following- 
day there was a lowering of the maxima. 

The third point of interest in the case was, 
that too much alcohol was administered along 
this period. I had ordered two table-spoons full 



— 328 — 



of whiskey with each bath, instead of which 
about three times the amount w^as given. The 
patient grew histerical, sentimental — was 
greatly excited and refused to take her baths, 
Avhile w^hereas during the first 8 — 10 days the 
patient took an interest in the accurate adminis- 
tration of the method. Hence great excitement 
in the house. And I am certain I would not 
have been able to continue in my course, had it 
not been for the excellent nurse, w^hom I had 
trained in a former case, and who had taken 
charge of this case, and this is the fourth point 
I wish to touch upon. There are cases, that can 
not properly be treated without a good nurse. A 
good nurse for this method however must not 
only have the good qualities of nurses in general, 
she must have t^vo other special ones: She 
must be commanding and determined in her 
make up, not yielding to the whims of the 
patient but able to exert genlte force, further 
she must have entered somewhat into the spirit of 
the method, so that she in the absence of the phy- 
sician, as Brand points out, can take his place. 
Having had but little experience with women 
under an overdose of spirits, I failed to recog- 
nize the cause of my patients condition. But 
when I did, and the alcohol was diminished, she 
became quiet, but her pulse did not go down un- 
til the disease declined, 



— 329 — 



It was surprising to see after the fever had 
left the patient, in what excellent condition she 
w^as. Her friends could not help remarking, 
that she had not in the least the appearance of 
a convalescent from typhoid fever. This of 
course was due to the excellent condition in 
which her digestive organs were kept under the 
influence of the baths. Her tongue always had 
but a thin coating, and her abdomen never was 
distended, although there was more gas there 
than normal — suflicient in fact to make the 
patient complain. — She thus was able to take a 
quart of milk and a good quantity of broth each 
day. Her urinary secretion was, as is frequent 
in the method, of light color and very abund- 
ant. There w^as no disturbance of the nervous 
system excepting the histerical condition men- 
tioned, due perhaps more to the alcohol than 
the fever. In spite of an acme of ten days there 
was no alarming symptom excepting the high 
pulse. 

Case XLII. 0. Sch. a boy 3 years of age, 
whose aunt living in an adjoining house, had 
died of typhoid fever two weeks previously, 
came under my treatment after being ill about a 
week. Although not apparently gravely ill 
then, he had diarrhoea, tympanites, enlarged 
spleen, a temp, of 104 and had not slept for 
four nights. After the first bath given in the 



— 330 — 



evening, he slept one hour and after the third 
for several hours, and kept on improving from 
the first day of treatment, so that the parents 
were delighted and did not heed the crying of 
the child, but carried out the treatment most ac- 
curately. The appetite of th ;^ patient returned 
after 4 — 5 days of treatment, and while the 
spleen was still s\Yollen and rose spots were pres- 
ent, he had only occasional outbursts of the 
fever and was hungry. AVe gave baths of 72 
of 10 minutes ditration; the first days six were 
necessary and later fewer. He required aboitt 
40 of them. 

From this house the bath-tub was taken to 
a four year old patient, who received 27 baths. 
She had a croupotis pneumonia. I gave the 
baths, before the diagnosis was established, and 
wdien on the 4th — 5th day chest -symptoms de- 
veloped, we continued the baths, which acted 
very pleasantly and j^roduced sleep. The temp- 
eratures in this case were 104 — 105, and the 
pulse 156, which after the baths wouldfall to 128. 

Case XL VI. Mhs K. The baths acted as 
they should, 52 baths were given, no medicines 
were required not even an opiate at night. I 
was very much amused at the mother, by no 
means a person of sanguine temperament, relat- 
ing to me the good points of the water treatment 
in contra distinction to the ordinary treatment^ 



— 331 — 



the properties of which she was acquainted with 
in as much as she had been nursing two of her 
children some time ago, who had typhoid fever. 
— Had she been reading this book she could 
have not done better in calling attention to the 
good points of the hydriatic treatment. She 
was converted. 

Case XLVII. Aug, Th. was of much in- 
terest to me because it was a case coming under 
the water-treatment late. It was a boy 9 J years 
old, ill 3-4 wrecks, w^hen seen, perfectly un- 
conscious, throwing himself around in the bed, 
and crying out so that the neighbors were dis- 
turbed. Perhaps he was not as seriously ill as 
he appeared to be, as his pulse was not 120, but 
it was a pitiful sight to see the child and to listen 
to his outcries. The parents were informed that 
-the child had no more fever and that he only 
^'had" it in his head; this assertion I suppose 
was based on thermometric measurments not 
made in the rectum. At least, for the next 
week I found the temperature to vary between 
103 to 100. — There was some cough, and three 
superficial bedsores varying from the size of a 
dollar to that of a nickel ; bowel symptoms were 
not marked, pupils widely dilated, — Temperature 
103 when I saw him at 9 p. m. and 101 two 
hours later. — As we were evidently near the end 
of the disease, cold baths seemed not indic^ited; 



— 332 — 



and I gave him a bath of 90° F. and towards 
the end, the bath lasting 10 minutes, used two 
pails of water of about 70 in affusions to the 
back of the head and back, after taking him 
from the bath I gave him ^ grain morphine, 
and in about | hour he slept quietly for several 
hours. Three hours after the first bath a second 
one was given followed by four hours of sleep. 
The bathing w^as repeated every three hours, the 
temperatures of the water having at times reduced 
to 85 and 80 if the fever went up to 102 or 103. 
As the patient w^as restless some time after each 
bath, I had in the third day given the baths 
only every six hours and had each bath pro- 
longed to 15 minutes; he also took ^ gr. mor- 
phine 2-3 times a day. On about the seventh 
day he again became restless, although not so 
much so, as before the water-treatment was be- 
gun, in spite of taking more of the opiate. I 
then ordered a warm bath of 95°, without affus- 
ions, (;f 30 minutes duration, with five grains of 
chloral and i\ gr. of morphine before the bath, 
and if necessary a second dose after the bath. 
This modification of the treatment was followed 
by quiet sleep, and was kept up; and proved 
sufficient to produce sleep and a qniet condition. 
The bronchitis disappeared in the first week of 
treatment, and the bedsores healed, and sweat- 
ing set in, the patient making a good recoverv. 



Together with this boy I began treating the 
father, sick only three days. Having my ex- 
cellent nur&e in the house he was treated accur- 
ately, receiving 41 baths in six days, — -for three 
days at 64°, when the fever was subdued, and 
he made a rapid recovery. 

Case XLIX. Aug. L. aet. was a fatal 
case. He had been able to be out doors two 
days before he came under treatment. The 
method was carried out well, large reductions of 
temperature being produced by the baths, and 
the fever curve being lowered, when on the 
10th. day of treatment a (pyaemic) swelling 
over the parotid developed, and the child died 
on the following day, having received over 50 
baths. — This case has discredited the method in 
my eyes more than any other. Although the 
tympanitic condition of the abdomen and the 
pronounced diorrhoea, which were present, when 
the patient came under treatment, make it prob- 
able that the disease was progressed further than 
two days, when the water-treatment was insti- 
tuted, yet the case was not a late one either, and 
the 50 baths though reducing the fever and un- 
proving the diarrhoea, did not prevent the 
blood -changes. 

Case LI. Mary L. Sister of case 49 is of 
interest because she was bathed from the very 
first days; the parents, although having not 



saved the first child, being satisfied' that the 
method was a good and nseful one carried it out 
accurately. 65 baths were given. I look upon 
this case as one of medium gravity. The fol- 
lowing table shows the number and temperature 
of baths etc. No diarrhoea. — Pulse over 120. 



9 

10 

11 

12 
13 
14 



Highest 
Temperature. 



.104 

.103 

,.102.5... 
,.103.75.. 

,.104 

,.105 

,.105 

,.104 

,.104 

,.103 

..103 

..102 

..102 

..100.5... 



Lowest Average ofiXo. of; Temperature 
Temp. I Maxima, jbaths.j of baths. 



.100 

.100 

.101 

.100 

.102 

.102 

.103 

.102 

.102 

.101 

.102 

...99.5... 

...97 

...95.5... 



j... 101. 75.. 
I...101.50., 
j... 101. 75., 
I. ..101. 5..., 

i...l03 

|... 103.25., 

...104 

...103 

...103 

...102 

...102.25. 

...100.5... 

...100 



.72. 
.68. 
.68. 
.68. 
.68. 
.64. 
.64. 
.64. 
.64. 
.64. 
.64. 
...0. 



Case LII. Anna L. 8 aet. sister of case 51, 
was also treated systematically from the second 
day on. I look upon this case as a grave one. 
Although baths of 64° were used from the b;- 
ginning on tjie 8th and 9th day delirium and in- 
voluntary evacuations were the symptoms neces- 
sitating the repetition of the baths every 2 
hours. The baths were of 12 to 13 minutes du- 
ration, 104 baths were given, 50 of 64"^ and the 
balance of 70°. Although I allowed after the 



combat with the fever was over warmer baths 
than 70, the mother preferred them not above 70 
she noticing that the colder baths did more 
good. In this case the pulse went up to 144 and 
over. I add a table illustrating the treatment 
and character of the case. 



i/dj Ui 

X i cl L LU c li L , 


L tJLu pel ajLUl c. 


i>l LI 111 Ut?l 
Ul Dctlllb, 


IcllipcltilLllc 

Ul UdllllS, 


• • V 


1 C\A 


A 




9 


1 OPi 


(\ 




q 




>1 


^ ^ 




104 5 


g 






1 OA P\ 


Q 




Q 


104 5 


9 




7 




9 




8 


.104 


7 




9 


102.5 


1 




10. 








11 


103 


5 




12 


104 


5 




13 


103.5 


4 




14 


103 


4 




15 


104 


5 




16 


103 


4 




17 








18 


103.5 


5....... 




19 


103 


o 




20 


103 


2 




21 








22 


lO.'^ 


1 









If asked regarding the value of the water- 
treatment I would answer, that as far as my in- 
dividual experience goes, I can say, that I know 
of no combination of remedies in or out of the 
pharmacopoeia (including the expectant treat- 



ment) that has the same effect for good or pro- 
duces such good results on the symptoms. I 
therefore expect that more cases of typhoid fever 
will recover under the cold-water-treatment than 
under any other plan. 

As far as the action on the individual symp- 
toms is concerned I have in the majority of cases 
seen the effect on the fever curve which Vogl 
describes, and where I have not seen it a more 
rigorous treatment might have brought about the 
change. Thus in a case where the temperatures 
Avere 104.5 and 104 the first day, there would be 
no change the second day, on the third day 104.5 
would appear not so often on the record, and in- 
stead of that 103.5 perhaps once or twice, on the 
fourth day 104.5 had disappeared, and the figure 
3 was seen oftener on the record, finally the 4 
would disappear and the 2 would present itself, 
so that one or two baths could be omitted. 

A reduction of the frequency of the pulse I 
have seen often, but not always. 

Thus in case i^o 48, a man, where 41 baths 
were given in six days, and Avhere the method 
was carried out to the letter the pulse was 100 
before the bathing and remained at that figure 
throughout the fever. In women and children 
likewise I do not recollect having seen 
marked changes in the pulse. The effect 
on the nervous system was satisfactory, my 



— 337 — 



patients resting quietly or sleeping between the 
baths. For the night however I generally gave 
and often had to give a suppository of mor- 
phine. The effect on the urine, the polyuria, 
I have observed very often, and where that was 
not the case, it may have been due to the patient 
not drinking enough- I always felt as though 
I had the best of the disease, when the urinary 
secretion was abundant, being of the opinion, 
that a normal blood pressure is necessary for its 
existence. Of course there were no dry lips and 
tongue, the latter generally being but thinly 
coated and an amount of nourishment could be 
taken, greater than could be taken by my pa- 
tients under medicinal treatment. Where I was 
most disappointed was in the action of the water 
on the bowels. In three cases of diarrhoea the 
effect seemed to be almost nothing in spite of 
compresses well applied. For at present how- 
ever I do not feel like calling to account the 
method for these or any deficiencies. It may be 
that it was lack of skill on my part, and that, 
these being my first years of trying the method, 
I was to blame. 

I have since January 1890 treated 54 cases 
of typhoid fever with water, and have had 
amongst these three deaths, I have had besides 26 
mild cases, of which some had some baths, but I 

put them down as not treated hydriatically, of these 
22 



— 338 — 



I lost one case. Of three cases, which I saw in 
consultation, none of which were bathed, all 
three died. Besides that I saw a moribund case 
and a case that had died before my first visit. 
The mild case which I lost was a case with good 
pulse, temperature below 103, diarrhoea marked 
but not excessive. In the 4th week he had pro- 
fuse intestinal hemorrhage, probably perforation 
and succumbed. Although I should feel very 
doubtful if such a case could be carried through 
safely by the water-treatment, if one were called 
as I Avas here, after the disease had been fully 
developed, I should however, if I had to treat 
the case over, treat it hydriatically , not liowever 
according to the formula. I should give about 
4 baths of 70 — 72 daily of 5 — 10 minutes dur- 
ation, with thorough rubbing, or use the cold 
affusions in the luke-warm half -bath, 5 — 10 
minutes duration, with compresses to the abdo- 
men, knowing however, that I should have to 
bear the odium of having produced the hemor- 
rhages, if theyshould take place. The family of 
course would say: the disease was so mild, 
that the patient would have surely gotten 
well, had it not been for those cold baths. 
The two cases which refused the baths also died. 
The second one was seen when ill a fcAv days. 
He seemed so little depressed by the disease, that 
I rather expected he would have the disease iu a 



— 339 — 



mild form; four to five weeks later his mothei' 
metliie on the street and expressed her regret, 
that the water-treatment had been refused. 
About a week later the patient died. This case 
again emphasizes the rule to treat all cases with 
water, though they may appear mild. 

Of course I ehall continue using the method 
and employ it more thoroughly and extensively. 
I for my part feel very grateful to Brand and to 
JiXrgensen, Vogl, Tripier and Bouveref and 
others, who have followed him, for enriching 
our armamentarium with this method. Every 
physician must have execrated the day on which 
he decided to study medicine, when he comes to 
see and feel the great dearth of reliable thera- 
peutical resources, and the formidable powers 
of disease; hence one should have expected, that 
the hydriatic method would have been hailed 
with delight. Whether one can save every case 
that comes under treatment in due time, by this 
method, I do not know. — I find it too difficult 
to believe that — . But even if that is not the 
case, so much is certain, that with this method a 
powerful means for doiug good is placed in the 
physician's hands, and I would no more think of 
placing any one dear to me personally, suffering 
from typhoid fever, into the hands of a physician, 
who does not act according to the principles'of 
Brandy than one who had to undergo an opera- 



— 340 — 



tion, into the hands of a surgeon, who does not 
act according to the principles of Lister. 

I conclude this little volume with. the fol- 
lowing words of Yogi: ^'In as much/' Vogl 
says, discussing the question, whether the meth- 
od should be made obligatory for the military 
physicians, ^-aslam not in favor of any re- 
straint upon the practice of medicine, I should 
discourage any sort of outward compulsion which 
necessarily must remain useless, if met by insuf- 
ficient inward conviction. The moral compul- 
sion however to form an opinion on the useful- 
ness of a method, no medical man can avoid, 
and this compulsion will induce him to give the 
same a trial. With the recognition of the 
harmlessness of the same, his courage and self- 
reliance and together with these his success will 
grow, forming the basis for his conviction. 

This road every physician must travel for 
himself, in order to reach the truth. He must 
not allow the less brilliant results of the first 
year of his trial to be a reproach to himself, or 
the cause of the discontinuation of the method. 

The physician however, who has become 
convinced of the life-saving power of the method 
and has not the courage to combat all obstacles, 
does not stand on the pinnacle of his profession." 







HOUR. 




Night. 




12 


Dav of Disease... 


1 


_v'age Redact, Tern 


2 


fo. evacuations 


3 


Abdomen, Character of dis- 


4 


- Spleen. — Roseola, Sweating. 


5 








6 
7 








8 






9 






10 






11 

Noon, 








12 







Day of tr 
Day of di 
] 


































































....1 


















] 


















] 


















] 


















] 
























































Pulse . , 


















No. evacu 
Urine oz. 

1> 0 . OL \)civ 

Temp, of 
Average r 



















































































Epitome: 
Disease, 
dominal 
sympton. 



suit 

Temp, of baths 



